Provider Demographics
NPI:1134141229
Name:PITTS, MICHAEL L (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:PITTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:256-355-0884
Practice Address - Street 1:124 EDWINA ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401
Practice Address - Country:US
Practice Address - Phone:251-216-5118
Practice Address - Fax:251-216-5120
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0884225100000X
ALPTH4229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015077Medicaid
AL5879677OtherAETNA
MS1033218524OtherGROUP NPI
MS09015077Medicaid