Provider Demographics
NPI:1073009312
Name:PITT, JILLIAN ANNETTE (AT, ATC)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ANNETTE
Last Name:PITT
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ANNETTE
Other - Last Name:SANBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3614 BENJAMIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2271
Mailing Address - Country:US
Mailing Address - Phone:989-709-1816
Mailing Address - Fax:
Practice Address - Street 1:4949 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1026
Practice Address - Country:US
Practice Address - Phone:248-655-5700
Practice Address - Fax:248-655-5701
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010007152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer