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General NPI Number Information
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NPI Number | 1174332019
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Entity Type | Individual
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Provider Name | HALLIE LITTLE LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 2911 CENTENARY BLVD
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City | SHREVEPORT
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State | LA
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Zip | 71104-3396
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Country | US
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Telephone | 318-869-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 9082 SIMPSON RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-8820
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Country | US
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Telephone | 318-936-3459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 339971
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License Number State | LA
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