Provider Demographics
NPI:1982271391
Name:PITTMAN, BLAKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 JUG FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-4833
Mailing Address - Country:US
Mailing Address - Phone:864-517-2626
Mailing Address - Fax:
Practice Address - Street 1:4134 JUG FACTORY RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-4833
Practice Address - Country:US
Practice Address - Phone:864-517-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist