Provider Demographics
NPI:1598101545
Name:PITTS, SAMANTHA NOELLE (DPT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:NOELLE
Last Name:PITTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:NOELLE
Other - Last Name:DRINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-236-2774
Mailing Address - Fax:706-236-2783
Practice Address - Street 1:2601A DEMERE RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1614
Practice Address - Country:US
Practice Address - Phone:912-634-9945
Practice Address - Fax:912-638-1584
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist