Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2091273 | TX |
NPI | 1396225033 |
---|---|
Provider Name | Michael Little |
First Address | Terrell, TX 75160-0009 |
Second Address | Terrell, TX 75160-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |