Provider Demographics
NPI:1538289871
Name:PITTMAN, DENISE MARIE (CMT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:902 SANTA FE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2120
Mailing Address - Country:US
Mailing Address - Phone:510-388-9039
Mailing Address - Fax:
Practice Address - Street 1:902 SANTA FE AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2120
Practice Address - Country:US
Practice Address - Phone:510-388-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERTIFIED660014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist