MEDICARE: MR. CORY CARTER HIGBEE PT

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	1890	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245222983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORY CARTER HIGBEE PT

Provider Business Mailing Address
First Line	:	3831 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1859
Country	:	US
Telephone Number	:	702-876-1733
Fax Number	:	702-878-2018

Provider Business Practice Location Address
First Line	:	375 N STEPHANIE ST STE 1111
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-8904
Country	:	US
Telephone Number	:	702-817-0799
Fax Number	:	702-456-0035

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	12/11/2019

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