MEDICARE: LEEANNE LITTLE PT, DPT

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	2251G0304X	Geriatric Physical Therapist	PT297884	CA
2	225100000X	Physical Therapist	PT297884	CA

General Provider Information

NPI Number	:	1427882679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEANNE LITTLE PT, DPT

Provider Business Mailing Address
First Line	:	123 E SAN CARLOS ST UNIT 89
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-3680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 CROW CANYON PL STE 270
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1157
Country	:	US
Telephone Number	:	800-734-1604
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	01/05/2025

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