Healthcare Provider Details

I. General information

NPI: 1063360543
Provider Name (Legal Business Name): LITTLEFOOT PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 NW PERSIMMON CT
GRAIN VALLEY MO
64029-8538
US

IV. Provider business mailing address

902 NW PERSIMMON CT
GRAIN VALLEY MO
64029-8538
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-2538
  • Fax:
Mailing address:
  • Phone: 417-926-2538
  • Fax: 816-277-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE MONTGOMERY
Title or Position: OWNER, PEDIATRIC PHYSICAL THERAPIST
Credential: PT, DPT, CEIM
Phone: 417-926-2538