Active NPI
Nicole Brianna Pitts
- Physical Therapy Assistant
- Detroit, MI
National Provider Identifier
1649815804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502006068
- Practice address
- 2630 E Jefferson Ave
Detroit, MI 48207-4129 - Phone
- (313) 259-7990
- NPI assigned
- Nov 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502006068 | MI | Primary |
Addresses
Primary practice location
2630 E Jefferson Ave
Detroit, MI 48207-4129
Mailing address
21920 Harding St
Oak Park, MI 48237-2540
Phone (248) 761-9197
Other practice location 1
121 Boatyard Dr
Fort Bragg, CA 95437-5751
Phone (707) 964-1208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502006068 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1649815804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21920 HARDING ST",
"city": "OAK PARK",
"state": "MI",
"postal_code": "482372540",
"telephone_number": "248-761-9197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 E JEFFERSON AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482074129",
"telephone_number": "313-259-7990"
}
],
"practiceLocations": [
{
"address_1": "121 Boatyard Dr",
"address_purpose": "LOCATION",
"city": "Fort Bragg",
"state": "CA",
"postal_code": "954375751",
"country_code": "US",
"telephone_number": "707-964-1208",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PITTS",
"first_name": "NICOLE",
"middle_name": "BRIANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-12",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502006068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.