Healthcare Provider Details

I. General information

NPI: 1790913069
Provider Name (Legal Business Name): AVA MARIE LITTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 COBURG RD SUITE B2
EUGENE OR
97401
US

IV. Provider business mailing address

2295 COBURG RD SUITE 102
EUGENE OR
97401-7486
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-7592
  • Fax: 541-505-7661
Mailing address:
  • Phone: 541-505-7592
  • Fax: 541-505-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2018
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2018
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: