Provider Demographics
NPI:1013431790
Name:PITCHER, ELEXIS JAYE
Entity Type:Individual
Prefix:
First Name:ELEXIS
Middle Name:JAYE
Last Name:PITCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1411
Mailing Address - Country:US
Mailing Address - Phone:989-883-9013
Mailing Address - Fax:
Practice Address - Street 1:396 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1411
Practice Address - Country:US
Practice Address - Phone:989-883-9013
Practice Address - Fax:989-883-9013
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer