MEDICARE: HIGGANUM PHYSICAL THERAPY, INC.

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	004600	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080004600CT05	OTHER	CT	ANTHEM BCBS

General Provider Information

NPI Number	:	1396871661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGGANUM PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 619
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-0619
Country	:	US
Telephone Number	:	860-345-2622
Fax Number	:	860-345-2626

Provider Business Practice Location Address
First Line	:	3A CANDLEWOOD HILL ROAD
Second Line	:
City	:	HIGGANUM
State	:	CT
Zip	:	06441-4202
Country	:	US
Telephone Number	:	860-345-2622
Fax Number	:	860-345-2626

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MICHELE R. GRASSO
Credential	:	RPT
Telephone Number	:	860-345-2622

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	10/05/2015

Similar Medicare Providers

1598715054 — MICHELE GRASSO RPT
Practice Location Address:

3A CANDLEWOOD HILL ROAD
HIGGANUM, CT
06441-4202

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1649754086 — JOHN WEBBER JR.
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3A CANDLEWOOD HILL RD
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06441-4202

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1093674384 — RACHEL WIDES VERINIS
Practice Location Address:

35 S DISH MILL RD
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06441-4362

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1811989106 — DR. KEVIN D CROSS DDS
Practice Location Address:

415 KILLINGWORTH RD
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06441-4370

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1972596997 — DANIELLE M. TABAKA P.A.
Practice Location Address:

11 ARKONA DR
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06441-4479

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1275529141 — DR. DALE E WILCOX DMD
Practice Location Address:

415 KILLINGWORTH RD
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06441-4370

Practice Phone: 860-345-4538
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Directions to “HIGGANUM PHYSICAL THERAPY, INC. ” Practice Location

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