Provider Demographics
NPI:1790987592
Name:PITTMAN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PITTMAN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-850-5246
Mailing Address - Street 1:632 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2540
Mailing Address - Country:US
Mailing Address - Phone:901-850-5246
Mailing Address - Fax:901-850-5226
Practice Address - Street 1:632 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2540
Practice Address - Country:US
Practice Address - Phone:901-850-5246
Practice Address - Fax:901-850-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5704261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736856OtherMEDICARE GROUP NUMBER
TN4143885OtherBLUE CROSS BLUE SHIELD OF TN GROUP PROVIDER NUMBER
TN1511716Medicaid
TNDG5965OtherRAILROAD MEDICARE PROVIDER NUMBER