Healthcare Provider Details

I. General information

NPI: 1255755112
Provider Name (Legal Business Name): MATTHEW HIGLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GARDEN OF EDEN RD
WILMINGTON DE
19803-1511
US

IV. Provider business mailing address

101 GARDEN OF EDEN RD
WILMINGTON DE
19803-1511
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-1536
  • Fax:
Mailing address:
  • Phone: 302-477-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ1-0003139
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: