Provider Demographics
NPI:1164890174
Name:PITMAN, RICKY (DPT)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:PITMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3149
Mailing Address - Country:US
Mailing Address - Phone:925-385-6067
Mailing Address - Fax:925-322-2337
Practice Address - Street 1:1084 BROWN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3149
Practice Address - Country:US
Practice Address - Phone:925-385-6067
Practice Address - Fax:925-322-2337
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist