Provider Demographics
NPI:1487385902
Name:LITTLETON, MINDY MAXINE (PTA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:MAXINE
Last Name:LITTLETON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2343
Mailing Address - Country:US
Mailing Address - Phone:814-437-9536
Mailing Address - Fax:
Practice Address - Street 1:103 N 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2343
Practice Address - Country:US
Practice Address - Phone:814-437-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004388225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant