Healthcare Provider Details

I. General information

NPI: 1184070633
Provider Name (Legal Business Name): WILLIAM CHAD PITTMON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CHERRY LN # 140
FORT WORTH TX
76116-3920
US

IV. Provider business mailing address

6913 CAMP BOWIE BLVD STE 177
FORT WORTH TX
76116-7169
US

V. Phone/Fax

Practice location:
  • Phone: 682-312-7693
  • Fax:
Mailing address:
  • Phone: 817-367-9882
  • Fax: 817-367-9886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1274755
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1274755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: