Provider Demographics
NPI:1740528363
Name:FITTS, MARY BEN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY BEN
Middle Name:
Last Name:FITTS
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 1:2709 18TH PL S
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1950
Mailing Address - Country:US
Mailing Address - Phone:205-492-3670
Mailing Address - Fax:
Practice Address - Street 1:2709 18TH PL S
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-1950
Practice Address - Country:US
Practice Address - Phone:205-492-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist