Provider Demographics
NPI:1699337311
Name:LITTLE, GENEA RENEA (MMP, LMT)
Entity type:Individual
Prefix:
First Name:GENEA
Middle Name:RENEA
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-0518
Mailing Address - Country:US
Mailing Address - Phone:870-831-5066
Mailing Address - Fax:
Practice Address - Street 1:210 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-3218
Practice Address - Country:US
Practice Address - Phone:870-831-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8646225700000X
AR8485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist