Provider Demographics
NPI:1952610438
Name:LITTLEFIELD PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:LITTLEFIELD PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-676-7693
Mailing Address - Street 1:PO BOX 893337
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-3337
Mailing Address - Country:US
Mailing Address - Phone:951-676-7693
Mailing Address - Fax:951-676-7830
Practice Address - Street 1:1445 N SUNRISE WAY
Practice Address - Street 2:STE. 102A
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3700
Practice Address - Country:US
Practice Address - Phone:760-322-1014
Practice Address - Fax:760-322-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28443261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0833139OtherMEDI-CAL