Provider Demographics
NPI:1568027704
Name:LITTLES, RAUKEESE NICHOLAUS ANTONIO (LPTA)
Entity type:Individual
Prefix:
First Name:RAUKEESE
Middle Name:NICHOLAUS ANTONIO
Last Name:LITTLES
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 EASTMONT DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3131
Mailing Address - Country:US
Mailing Address - Phone:251-378-1883
Mailing Address - Fax:
Practice Address - Street 1:4201 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-2412
Practice Address - Country:US
Practice Address - Phone:205-428-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA8066225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant