Provider Demographics
NPI:1780707141
Name:PITTS, MICHELLE M (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
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 1:77 W FOREST AVE
Mailing Address - Street 2:301
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-214-2836
Mailing Address - Fax:928-214-2837
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:301
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-214-2836
Practice Address - Fax:928-214-2837
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832974Medicaid