NPIMap

Organization Active NPI

Pittman Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Collierville, TN
National Provider Identifier
1790987592
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5704 Issued in TN
Legal business name
PITTMAN PHYSICAL THERAPY LLC
Practice address
632 W Poplar Ave
Collierville, TN 38017-2540
Phone
(901) 850-5246
Fax
(901) 850-5226
NPI assigned
Jun 4, 2007
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeremy H PittmanNPI 1912966060
Title
President
Phone
(901) 850-5246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 5704 TN Primary

Addresses

Primary practice location

632 W Poplar Ave
Collierville, TN 38017-2540

Mailing address

632 W Poplar Ave
Collierville, TN 38017-2540
Phone (901) 850-5246

Other practice location 1

2631 McIngvale Rd Ste 108
Hernando, MS 38632-5936
Phone (662) 469-9054

Other practice location 2

9087 Poplar Ave Ste 103
Germantown, TN 38138-7846
Phone (901) 627-3280

Other identifiers 4

IdentifierTypeStateIssuer
3736856OtherTNMEDICARE GROUP NUMBER
4143885OtherTNBLUE CROSS BLUE SHIELD OF TN GROUP PROVIDER NUMBER
DG5965OtherTNRAILROAD MEDICARE PROVIDER NUMBER
1511716MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081001000307 TN Part B Supplier - Clinic/Group Practice 5991804031 Receives reassigned benefits from 13 practitioners
Practice locations: Collierville, TN
O20230206002512 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5991804031 Receives reassigned benefits from 9 practitioners
Practice locations: Hernando, MS

National Provider Directory

National Provider Directory

Locations

622 W Poplar Ave
Collierville, TN 38017

632 W Poplar Ave
Collierville, TN 38017
Phone (901) 850-5246

9087 Poplar Ave
Ste 103
Germantown, TN 38138
Phone (901) 627-3280

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1790987592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 W POPLAR AVE",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172540",
            "telephone_number": "901-850-5246",
            "fax_number": "901-850-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 W POPLAR AVE",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172540",
            "telephone_number": "901-850-5246",
            "fax_number": "901-850-5226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2631 McIngvale Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Hernando",
            "state": "MS",
            "postal_code": "386325936",
            "country_code": "US",
            "telephone_number": "662-469-9054",
            "fax_number": "662-469-9126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9087 Poplar Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381387846",
            "country_code": "US",
            "telephone_number": "901-627-3280",
            "fax_number": "901-627-3254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PITTMAN PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "PITTMAN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-850-5246"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TN",
            "license": "5704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "3736856",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TN GROUP PROVIDER NUMBER",
            "identifier": "4143885",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROVIDER NUMBER",
            "identifier": "DG5965",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511716",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.