Provider Demographics
NPI:1811300676
Name:LITTLE, ELLEN (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:LITTLE
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 1:800 S KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-2106
Mailing Address - Country:US
Mailing Address - Phone:573-517-0853
Mailing Address - Fax:
Practice Address - Street 1:800 S KINGS HWY
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-2106
Practice Address - Country:US
Practice Address - Phone:573-517-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist