Provider Demographics
NPI:1386989382
Name:LYTTLE, JANE R (PT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:LYTTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:R
Other - Last Name:SIMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 FEDERAL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:366 FEDERAL HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3602
Practice Address - Country:US
Practice Address - Phone:603-493-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist