Organization
PITTMAN PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY H PITTMAN (PRESIDENT)
(901) 850-5246
Entity
Organization
Contact information
Practice address
632 W POPLAR AVE, COLLIERVILLE, TN 38017-2540
(901) 850-5246
(901) 850-5226
Mailing address
632 W POPLAR AVE, COLLIERVILLE, TN 38017-2540
(901) 850-5246
(901) 850-5226
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5704
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1511716
—
TN
01
—
3736856
MEDICARE GROUP NUMBER
TN
01
—
4143885
BLUE CROSS BLUE SHIELD OF TN GROUP PROVIDER NUMBER
TN
01
—
DG5965
RAILROAD MEDICARE PROVIDER NUMBER
TN
Enumeration date
06/04/2007
Last updated
03/11/2024
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