Provider Demographics
NPI:1578962817
Name:LITTENBERG, ALAN SCOTT
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:LITTENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7654
Mailing Address - Country:US
Mailing Address - Phone:817-335-7946
Mailing Address - Fax:817-335-7947
Practice Address - Street 1:160 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7654
Practice Address - Country:US
Practice Address - Phone:817-335-7946
Practice Address - Fax:817-335-7947
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1248780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist