Healthcare Provider Details

I. General information

NPI: 1629302559
Provider Name (Legal Business Name): LITTLE HANDS LITTLE FEET PEDIATRIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 MAIN ST.
EXMORE VA
23350-0252
US

IV. Provider business mailing address

PO BOX 252
EXMORE VA
23350-0252
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-5437
  • Fax:
Mailing address:
  • Phone: 757-442-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305005459
License Number StateVA

VIII. Authorized Official

Name: JENNIFER K. BRIDGES
Title or Position: PEDIATRIC PHYSICAL THERAPIST
Credential: PT
Phone: 757-442-5437