Provider Demographics
NPI:1932621851
Name:LITTLE, ROSS (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 WATONGA BLVD APT 3214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5346
Mailing Address - Country:US
Mailing Address - Phone:903-815-1747
Mailing Address - Fax:
Practice Address - Street 1:17863 JUNEBERRY SEED ST
Practice Address - Street 2:
Practice Address - City:HOCKLEY
Practice Address - State:TX
Practice Address - Zip Code:77447-2354
Practice Address - Country:US
Practice Address - Phone:903-815-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
TXAT78992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program