Provider Demographics
NPI:1760965768
Name:LITTLEJOHN, KARA M (PTA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:LITTLEJOHN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 CASTLE PINES CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1194
Mailing Address - Country:US
Mailing Address - Phone:618-830-4639
Mailing Address - Fax:
Practice Address - Street 1:1111 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-5589
Practice Address - Country:US
Practice Address - Phone:618-692-2273
Practice Address - Fax:618-692-5073
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-004457225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant