Individual
JASON S LITTLEDIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
77 S 400 W, SPANISH FORK, UT 84660-2053
(801) 798-1626
(801) 798-1236
Mailing address
77 S 400 W, SPANISH FORK, UT 84660-2053
(801) 798-1626
(801) 798-1236
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
48738752401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48738752400001
BCBS PROVIDER ID#
UT
01
—
48738752402001
WRHN PROVIDER ID
TX
01
—
64-00582
UNITED HEALTHCARE ID#
—
01
—
64411
PEHP PROVIDER ID
UT
05
—
D3911/870578539003
—
UT
01
—
QM0000076331
ALTIUS PROVIDER ID
UT
Enumeration date
07/29/2005
Last updated
04/18/2008
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