Provider Demographics
NPI:1306208889
Name:PITNEY, WILLIAM A III (ATC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:PITNEY
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W LINCOLN HWY
Mailing Address - Street 2:NORTHERN ILLINIOS UNIVERSITY
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 W LINCOLN HWY
Practice Address - Street 2:NORTHERN ILLINIOS UNIVERSITY
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2828
Practice Address - Country:US
Practice Address - Phone:815-753-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0006902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer