Healthcare Provider Details

I. General information

NPI: 1053533232
Provider Name (Legal Business Name): KEVIN MICHAEL PITTS LMT,NMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 CAHABA VALLEY RD
BIRMINGHAM AL
35242-6402
US

IV. Provider business mailing address

1309 ATKINS TRIMM BLVD
HOOVER AL
35226-2016
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-6510
  • Fax:
Mailing address:
  • Phone: 205-266-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1629
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: