MEDICARE: BRAD LITTLE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3540	OTHER	TN	LICENSE #

General Provider Information

NPI Number	:	1972613610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD LITTLE

Provider Business Mailing Address
First Line	:	2009 SAINT MICHAELS LN
Second Line	:
City	:	CEDAR HILL
State	:	TN
Zip	:	37032-4971
Country	:	US
Telephone Number	:	615-696-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3913
Country	:	US
Telephone Number	:	615-384-3836
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ BRAD LITTLE ” Practice Location

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