Healthcare Provider Details

I. General information

NPI: 1457510943
Provider Name (Legal Business Name): BREE ANN PITTMAN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W 86TH ST
INDIANAPOLIS IN
46260-2002
US

IV. Provider business mailing address

1707 W 86TH ST
INDIANAPOLIS IN
46260-2002
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5642
  • Fax: 317-415-5635
Mailing address:
  • Phone: 317-415-5642
  • Fax: 317-415-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05007163A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: