MEDICARE: FORTITUDE PERFORMANCE PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1194690081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDE PERFORMANCE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	2820 VILLAGE PKWY STE 625
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3295
Country	:	US
Telephone Number	:	469-830-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 VILLAGE PKWY STE 625
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3295
Country	:	US
Telephone Number	:	469-830-4405
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	DR. ZACHARY DIXON
Credential	:	DPT
Telephone Number	:	469-830-4405

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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