Provider Demographics
NPI:1225240435
Name:LITTELL, TARA RENAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RENAE
Last Name:LITTELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44309 N US HWY 60
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85342-9661
Mailing Address - Country:US
Mailing Address - Phone:928-231-4503
Mailing Address - Fax:928-684-8717
Practice Address - Street 1:2000 W WICKENBURG WAY STE 200
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1074
Practice Address - Country:US
Practice Address - Phone:928-668-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist