Individual
LAURA ELIZABETH PITTENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST STE 103, PONTIAC, IL 61764-9774
(815) 844-4062
(815) 844-4962
Mailing address
205 SCOTT DR, DWIGHT, IL 60420-1628
(815) 579-1039
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096001831
IL
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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