Basic Information
| Provider Information | |||||||||
| NPI: | 1134141229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITTS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 JOHNSTON ST SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563501764 | ||||||||
| FaxNumber: | 2563550884 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 EDWINA ST | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512165118 | ||||||||
| FaxNumber: | 2512165120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0884 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTH4229 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 09015077 | 05 | MS | MEDICAID | 5879677 | 01 | AL | AETNA | OTHER | 1033218524 | 01 | MS | GROUP NPI | OTHER |