Provider Demographics
NPI:1083985063
Name:PITTS, SEAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:GA
Mailing Address - Zip Code:30711-0174
Mailing Address - Country:US
Mailing Address - Phone:423-653-1390
Mailing Address - Fax:
Practice Address - Street 1:1720 N MCDONALD ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8229
Practice Address - Country:US
Practice Address - Phone:972-562-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4970225200000X
TX2086778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant