Basic Information
| Provider Information | |||||||||
| NPI: | 1346483310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LITTREAL | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LICENSED PHYSICAL TH | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1657 | ||||||||
| Address2: | 104 N. SANDERS AVENUE HEARTLAND REHABILITATION SERVICES | ||||||||
| City: | CHILHOWIE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766468774 | ||||||||
| FaxNumber: | 2766465576 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 N. SANDERS AVENUE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC. | ||||||||
| City: | CHILHOWIE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766468774 | ||||||||
| FaxNumber: | 2766465576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2009 | ||||||||
| LastUpdateDate: | 04/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2306602586 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.