Provider Demographics
NPI:1568285047
Name:LITTLE, SKYLER
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:LITTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 W SOUTH JORDAN PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9372
Mailing Address - Country:US
Mailing Address - Phone:801-254-5800
Mailing Address - Fax:801-254-1696
Practice Address - Street 1:1098 W SOUTH JORDAN PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9372
Practice Address - Country:US
Practice Address - Phone:801-254-5800
Practice Address - Fax:801-254-1696
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13408625-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy