Provider Demographics
NPI:1972613610
Name:LITTLE, BRAD
Entity type:Individual
Prefix:
First Name:BRAD
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 1:2009 SAINT MICHAELS LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37032-4971
Mailing Address - Country:US
Mailing Address - Phone:615-696-0012
Mailing Address - Fax:
Practice Address - Street 1:2009 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3913
Practice Address - Country:US
Practice Address - Phone:615-384-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3540OtherLICENSE #