Healthcare Provider Details

I. General information

NPI: 1467506691
Provider Name (Legal Business Name): LITTLEFIELD PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41421 DATE STREET SUITE 101
MURRIETA CA
92562-7079
US

IV. Provider business mailing address

PO BOX 893337
TEMECULA CA
92589-3337
US

V. Phone/Fax

Practice location:
  • Phone: 855-454-3784
  • Fax: 855-454-3784
Mailing address:
  • Phone: 855-454-3784
  • Fax: 855-454-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28443
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number024121
License Number StateCA

VIII. Authorized Official

Name: MS. MELISSA DALY LITTLEFIELD
Title or Position: OWNER/ CEO
Credential: PT
Phone: 855-454-3784