Healthcare Provider Details

I. General information

NPI: 1679892020
Provider Name (Legal Business Name): DAWN MARIE HIGGINS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE DELAR

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N LAKEWOOD DR STE 100
COEUR D ALENE ID
83814-2635
US

IV. Provider business mailing address

850 W IRONWOOD DR STE 202
COEUR D ALENE ID
83814-4903
US

V. Phone/Fax

Practice location:
  • Phone: 208-966-4476
  • Fax: 208-966-4475
Mailing address:
  • Phone: 208-664-2175
  • Fax: 208-664-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number36588
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8971540
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: