Healthcare Provider Details

I. General information

NPI: 1821989195
Provider Name (Legal Business Name): THEODORE TITA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SHOAF DR
IRVING TX
75061-2553
US

IV. Provider business mailing address

1609 MACK LN
LITTLE ELM TX
75068-1795
US

V. Phone/Fax

Practice location:
  • Phone: 972-579-1919
  • Fax:
Mailing address:
  • Phone: 918-815-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number215780
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: