Provider Demographics
NPI:1326019894
Name:LITTERAL, SAMUEL H (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:LITTERAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 ENSLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4017
Mailing Address - Country:US
Mailing Address - Phone:304-697-8451
Mailing Address - Fax:304-429-7383
Practice Address - Street 1:4120 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1127
Practice Address - Country:US
Practice Address - Phone:304-429-7381
Practice Address - Fax:304-429-7383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVLI4172561Medicare PIN
WVP00263332Medicare PIN