MEDICARE: LORI FLYNN PITTSLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501002492	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275034233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI FLYNN PITTSLEY PT

Provider Business Mailing Address
First Line	:	4851 E PICKARD ST STE 2600
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-775-1664
Fax Number	:	989-775-1604

Provider Business Practice Location Address
First Line	:	4851 E PICKARD ST STE 2600
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-775-1664
Fax Number	:	989-775-1604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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Directions to “ LORI FLYNN PITTSLEY PT” Practice Location

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