MEDICARE: BRENT LITTLE

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	225100000X	Physical Therapist	PT1095339	TX

General Provider Information

NPI Number	:	1356582605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT LITTLE

Provider Business Mailing Address
First Line	:	613 BASCOM RD
Second Line	:
City	:	WHITEHOUSE
State	:	TX
Zip	:	75791-3222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 MAGGIE SESSIONS ST
Second Line	:
City	:	ALTO
State	:	TX
Zip	:	75925-5988
Country	:	US
Telephone Number	:	936-858-2255
Fax Number	:

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

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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Directions to “ BRENT LITTLE ” Practice Location

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