| Name: | Little Victories Pediatric Therapy LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Apr 2022 (3 years ago) |
| Entity Number: | 001-012-905 |
| Register Number: | 001012905 |
| County: | Baldwin |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 8909 Rand AvenueDaphen, AL 36526 |
| Registered Office Street Address ZIP Code: | 36526 |
| Registered Office Mailing Address: | 18782 Outlook DriveLoxley, AL 36551 |
| Registered Office Mailing Address ZIP Code: | 36551 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578204988 | 2022-04-07 | 2022-04-07 | 18782 OUTLOOK DR, LOXLEY, AL, 365513610, US | 8909 RAND AVE, DAPHNE, AL, 365269126, US | |||||||||||||||||||
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| Phone | +1 334-830-8493 |
Authorized person
| Name | PATRICIA HENRY GOGGINS |
| Role | SPEECH- LANGUAGE PATHOLOGIST |
| Phone | 3348308493 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 219155 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| Goggins, Patricia H | Agent | 8909 Rand AvenueDaphne, AL 36526 |
| Name | Role | Address |
|---|---|---|
| Goggins, Patricia H | Organizer | 8909 Rand AvenueDaphne, AL 36526 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
