Provider Demographics
NPI:1245354836
Name:PITTMAN, ANDREA DANIELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DANIELLE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:RT 20
Mailing Address - City:READER
Mailing Address - State:WV
Mailing Address - Zip Code:26167-0010
Mailing Address - Country:US
Mailing Address - Phone:304-386-4903
Mailing Address - Fax:
Practice Address - Street 1:201 WOOD ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1523
Practice Address - Country:US
Practice Address - Phone:304-652-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant