Provider Demographics
NPI:1972122984
Name:LITTLE ROOS, LLC
Entity Type:Organization
Organization Name:LITTLE ROOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-465-4444
Mailing Address - Street 1:18291 N PIMA RD STE 110-B326
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5697
Mailing Address - Country:US
Mailing Address - Phone:480-401-1848
Mailing Address - Fax:480-923-0950
Practice Address - Street 1:18291 N PIMA RD STE 110-B326
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5697
Practice Address - Country:US
Practice Address - Phone:480-401-1848
Practice Address - Fax:480-923-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty