Basic Information
| Provider Information | |||||||||
| NPI: | 1619307261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITTMAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16083 SW UPPER BOONES FERRY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5036399699 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 12TH ST SE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537353606 | ||||||||
| FaxNumber: | 2533519807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 60928 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT60275990 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P01311334 | 01 | WA | MEDICARE RAILROAD | OTHER | 1619307261 | 05 | WA | MEDICAID | 0320280 | 01 | WA | DEPT. OF LABOR AND INDUSTRIES | OTHER | 500744575 | 05 | OR | MEDICAID |