Provider Demographics
NPI:1881970200
Name:PITTMAN, ALEX ALTON (PT PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:ALTON
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:PT PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0368
Mailing Address - Country:US
Mailing Address - Phone:360-491-8439
Mailing Address - Fax:360-491-6328
Practice Address - Street 1:3901 CAPITAL MALL DR SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6025
Practice Address - Country:US
Practice Address - Phone:318-323-8451
Practice Address - Fax:318-361-2613
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6554225100000X
LAPA.200822363A00000X
ALPA987363AS0400X
WAPA60991959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2142842Medicaid
AL164995Medicaid
LA2395165Medicaid