Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1274755 | TX |
Y | 2251N0400X | Physical Therapist - Neurology | 1274755 | TX |
NPI | 1184070633 |
---|---|
Provider Name | William Chad Pittmon |
First Address | Fort Worth, TX 76116-7169 |
Second Address | Fort Worth, TX 76116-3920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2016 |
Last Update Date | 27/03/2019 |