Provider Demographics
NPI:1477939775
Name:PITTMAN, CHASIDY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHASIDY
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PUTNAM ST
Mailing Address - Street 2:PO BOX 941
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3005
Mailing Address - Country:US
Mailing Address - Phone:740-373-9446
Mailing Address - Fax:740-373-7074
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-1022
Practice Address - Country:US
Practice Address - Phone:740-472-1656
Practice Address - Fax:740-472-0328
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.015136208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366582Medicare PIN