Provider Demographics
NPI:1760647333
Name:LITTLE, EVAN MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:MATTHEW
Last Name:LITTLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7340 S ALTON WAY
Mailing Address - Street 2:STE 11-D
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2323
Mailing Address - Country:US
Mailing Address - Phone:720-493-1181
Mailing Address - Fax:720-493-1191
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-702-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34689225100000X
CO105972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist