Provider Demographics
NPI:1790129104
Name:PITTS, CHANNING (PT)
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PARKWAY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3018
Mailing Address - Country:US
Mailing Address - Phone:609-883-7528
Mailing Address - Fax:609-883-5947
Practice Address - Street 1:1230 PARKWAY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3018
Practice Address - Country:US
Practice Address - Phone:609-883-7528
Practice Address - Fax:609-883-5947
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01492200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist