Provider Demographics
NPI:1790913069
Name:LITTON, AVA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:LITTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 COBURG RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7486
Mailing Address - Country:US
Mailing Address - Phone:541-505-7592
Mailing Address - Fax:541-505-7661
Practice Address - Street 1:2295 COBURG RD
Practice Address - Street 2:SUITE B2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-505-7592
Practice Address - Fax:541-505-7661
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2018OtherOREGON LICENSE