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General NPI Number Information
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NPI Number | 1932621851
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Entity Type | Individual
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Provider Name | ROSS LITTLE MAT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 17863 JUNEBERRY SEED ST
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City | HOCKLEY
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State | TX
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Zip | 77447-2354
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Country | US
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Telephone | 903-815-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 WATONGA BLVD APT 3214
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City | HOUSTON
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State | TX
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Zip | 77092-5346
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Country | US
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Telephone | 903-815-1747
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7899
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License Number State | TX
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