Provider Demographics
NPI:1184070633
Name:PITTMON, WILLIAM CHAD (PT, DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHAD
Last Name:PITTMON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 CAMP BOWIE BLVD
Mailing Address - Street 2:STE 177
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7169
Mailing Address - Country:US
Mailing Address - Phone:817-367-9882
Mailing Address - Fax:817-367-9886
Practice Address - Street 1:2600 CHERRY LN # 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3920
Practice Address - Country:US
Practice Address - Phone:682-312-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274755225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist