Healthcare Provider Details

I. General information

NPI: 1427882679
Provider Name (Legal Business Name): LEEANNE LITTLE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 CROW CANYON PL STE 270
SAN RAMON CA
94583-1157
US

IV. Provider business mailing address

123 E SAN CARLOS ST UNIT 89
SAN JOSE CA
95112-3680
US

V. Phone/Fax

Practice location:
  • Phone: 800-734-1604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT297884
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT297884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: