MEDICARE: BRADLEY THOMAS LITTLE PTA

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	225200000X	Physical Therapy Assistant	2148466	TX

General Provider Information

NPI Number	:	1164179768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY THOMAS LITTLE PTA

Provider Business Mailing Address
First Line	:	492 PASO FINO ST
Second Line	:
City	:	ROBINSON
State	:	TX
Zip	:	76706-7640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 PASO FINO ST
Second Line	:
City	:	ROBINSON
State	:	TX
Zip	:	76706-7640
Country	:	US
Telephone Number	:	940-521-7833
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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Directions to “ BRADLEY THOMAS LITTLE PTA” Practice Location

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