Provider Demographics
NPI:1336659861
Name:LITTLE, TITIANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TITIANNA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TITIANNA
Other - Middle Name:
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:32819 YUCAIPA BOULEVARD #3
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-797-9010
Mailing Address - Fax:909-797-9046
Practice Address - Street 1:32819 YUCAIPA BOULEVARD #3
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-797-9010
Practice Address - Fax:909-797-9046
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist