Healthcare Provider Details

I. General information

NPI: 1710283585
Provider Name (Legal Business Name): LITTLE FEET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 GILCREST RD
COLORADO SPRINGS CO
80906-4557
US

IV. Provider business mailing address

590 GILCREST RD
COLORADO SPRINGS CO
80906-4557
US

V. Phone/Fax

Practice location:
  • Phone: 719-964-0114
  • Fax:
Mailing address:
  • Phone: 719-964-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3666
License Number StateCO

VIII. Authorized Official

Name: DAWN R THOMPSON
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 719-964-0114