Provider Demographics
NPI:1447721170
Name:LITTLE, HUGH CAMERON SR (PT)
Entity type:Individual
Prefix:MR
First Name:HUGH
Middle Name:CAMERON
Last Name:LITTLE
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:FENNVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49408-9747
Mailing Address - Country:US
Mailing Address - Phone:269-543-4706
Mailing Address - Fax:269-543-4706
Practice Address - Street 1:2172 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-9747
Practice Address - Country:US
Practice Address - Phone:269-543-4706
Practice Address - Fax:269-543-4706
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty