Provider Demographics
NPI:1144815341
Name:LITTLE, TALEN (DPT)
Entity type:Individual
Prefix:
First Name:TALEN
Middle Name:
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3689 W EL GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4104
Mailing Address - Country:US
Mailing Address - Phone:801-455-1492
Mailing Address - Fax:
Practice Address - Street 1:195 FEATHER WAY
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9352
Practice Address - Country:US
Practice Address - Phone:307-224-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-2049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist