MEDICARE: LINDA LITTLE L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	034734	TX

General Provider Information

NPI Number	:	1053618793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LITTLE L.M.T.

Provider Business Mailing Address
First Line	:	2501 PARKVIEW DIVE
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5816
Country	:	US
Telephone Number	:	817-907-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 PARKVIEW DR
Second Line	:	SUITE 115
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5824
Country	:	US
Telephone Number	:	817-907-0618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	08/03/2015

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