MEDICARE: ZACHARY TITTLE

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	2251X0800X	Orthopedic Physical Therapist	1395908	TX
2	225100000X	Physical Therapist	1395908	TX

General Provider Information

NPI Number	:	1780416453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY TITTLE

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5129 N GARLAND AVE STE 600
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-2741
Country	:	US
Telephone Number	:	469-838-4072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	01/27/2026

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Directions to “ ZACHARY TITTLE ” Practice Location

Language	Start Address	Practice Location

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