Provider Demographics
NPI:1992487417
Name:PITMAN, ROBERT THOMAS
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:PITMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9307
Mailing Address - Country:US
Mailing Address - Phone:623-999-3536
Mailing Address - Fax:
Practice Address - Street 1:5403 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3925
Practice Address - Country:US
Practice Address - Phone:563-296-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health