Provider Demographics
NPI:1316590094
Name:PITMAN, KATHRYN MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:PITMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 TOWN CENTRE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6190
Mailing Address - Country:US
Mailing Address - Phone:541-286-8431
Mailing Address - Fax:541-690-1222
Practice Address - Street 1:945 TOWN CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6190
Practice Address - Country:US
Practice Address - Phone:541-286-8431
Practice Address - Fax:541-690-1222
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0233855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist