=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467506691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLEFIELD PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 02/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41421 DATE STREET SUITE 101
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-7079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-454-3784
-----------------------------------------------------
Fax | 855-454-3784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 893337
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92589-3337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-454-3784
-----------------------------------------------------
Fax | 855-454-3784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ CEO
-----------------------------------------------------
Name | MS. MELISSA DALY LITTLEFIELD
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 855-454-3784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 024121
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 28443
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------