Provider Demographics
NPI:1538613203
Name:LITTLE, BRENT (DPT)
Entity type:Individual
Prefix:
First Name:BRENT
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 1:754 N COLLEGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5822
Mailing Address - Country:US
Mailing Address - Phone:208-734-5313
Mailing Address - Fax:208-736-1582
Practice Address - Street 1:754 N COLLEGE RD STE D
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5822
Practice Address - Country:US
Practice Address - Phone:208-734-5313
Practice Address - Fax:208-736-1582
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111975225100000X
IDPT-8359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist