Provider Demographics
NPI:1154419729
Name:LITTLE, SUSAN CANTRELL (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CANTRELL
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 1:304 TUMBLEWEED TER
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5624
Mailing Address - Country:US
Mailing Address - Phone:846-877-1449
Mailing Address - Fax:
Practice Address - Street 1:304 TUMBLEWEED TER
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5624
Practice Address - Country:US
Practice Address - Phone:846-877-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist