Individual
DALVIN D LITTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
604 W WATER ST, WAUKEGAN, IL 60085-5431
(847) 406-7530
Mailing address
604 W WATER ST, WAUKEGAN, IL 60085-5431
(847) 406-7530
Taxonomy
Speciality
Code
Description
License number
State
2251E1300X
Clinical Electrophysiology Physical Therapist
Primary
00124964401
IL
225200000X
Physical Therapy Assistant
00124964401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34016496101L
—
IL
Enumeration date
07/11/2023
Last updated
07/11/2023
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