MEDICARE: MRS. MICHELLE LEIGH HIGDON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	004901	KY

General Provider Information

NPI Number	:	1033247259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE LEIGH HIGDON PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	RINEYVILLE
State	:	KY
Zip	:	40162-0175
Country	:	US
Telephone Number	:	270-766-2484
Fax Number	:	270-763-0054

Provider Business Practice Location Address
First Line	:	6184 RINEYVILLE RD
Second Line	:
City	:	RINEYVILLE
State	:	KY
Zip	:	40162-9770
Country	:	US
Telephone Number	:	270-765-5633
Fax Number	:	270-763-0054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/13/2012

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