Healthcare Provider Details

I. General information

NPI: 1245553395
Provider Name (Legal Business Name): MEREDITH S. TITTLE, P.T., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BRYCE LN
FLOWER MOUND TX
75077-7038
US

IV. Provider business mailing address

4040 BRYCE LN
FLOWER MOUND TX
75077-7038
US

V. Phone/Fax

Practice location:
  • Phone: 940-241-1215
  • Fax: 940-455-2041
Mailing address:
  • Phone: 940-241-1215
  • Fax: 940-455-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH SCHUCK TITTLE
Title or Position: OWNER
Credential: PT
Phone: 940-241-1215