Provider Demographics
NPI:1417507617
Name:LITTLE, MARIA THERESA
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 L DON DODSON DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1844
Mailing Address - Country:US
Mailing Address - Phone:817-288-0121
Mailing Address - Fax:817-288-0214
Practice Address - Street 1:2412 AVONDALE HASLET RD STE 200
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3444
Practice Address - Country:US
Practice Address - Phone:817-717-9111
Practice Address - Fax:817-717-8999
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2150967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant