MEDICARE: PITTMAN PHYSICAL THERAPY LLC

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	261QP2000X	Physical Therapy Clinic/Center	5704	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3736856	OTHER	TN	MEDICARE GROUP NUMBER
4	DG5965	OTHER	TN	RAILROAD MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4143885	OTHER	TN	BLUE CROSS BLUE SHIELD OF TN GROUP PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790987592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITTMAN PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	632 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2540
Country	:	US
Telephone Number	:	901-850-5246
Fax Number	:	901-850-5226

Provider Business Practice Location Address
First Line	:	632 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2540
Country	:	US
Telephone Number	:	901-850-5246
Fax Number	:	901-850-5226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEREMY H PITTMAN
Credential	:
Telephone Number	:	901-850-5246

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	03/11/2024

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Directions to “PITTMAN PHYSICAL THERAPY LLC ” Practice Location

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