Provider Demographics
NPI:1609906858
Name:PITKOFF, GILBERT JAY (LMP, RRT)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:JAY
Last Name:PITKOFF
Suffix:
Gender:M
Credentials:LMP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9305
Mailing Address - Country:US
Mailing Address - Phone:509-735-4338
Mailing Address - Fax:509-735-2038
Practice Address - Street 1:5310 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9305
Practice Address - Country:US
Practice Address - Phone:509-735-4338
Practice Address - Fax:509-735-2038
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist