Provider Demographics
NPI:1881078335
Name:PITTS, JEFFREY TAYLOR (PTA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TAYLOR
Last Name:PITTS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-9495
Mailing Address - Country:US
Mailing Address - Phone:850-215-8844
Mailing Address - Fax:850-215-6644
Practice Address - Street 1:807 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-9495
Practice Address - Country:US
Practice Address - Phone:850-215-8844
Practice Address - Fax:850-215-6644
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 25779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant