Provider Demographics
NPI:1194157461
Name:LYTTLE, KADINE VERONIQUE (PT)
Entity type:Individual
Prefix:MS
First Name:KADINE
Middle Name:VERONIQUE
Last Name:LYTTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KADINE
Other - Middle Name:VERONIQUE
Other - Last Name:WALFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1165 MORRIS PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1915
Mailing Address - Country:US
Mailing Address - Phone:718-430-8600
Mailing Address - Fax:
Practice Address - Street 1:1225 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1949
Practice Address - Country:US
Practice Address - Phone:718-839-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist