Healthcare Provider Details

I. General information

NPI: 1437487147
Provider Name (Legal Business Name): DAVID C. HIGGINS PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WARREN AVE SUITE 4
PORTLAND ME
04103-1006
US

IV. Provider business mailing address

11 MAIN ST STE 7 PMB 252
WESTBROOK ME
04092-4786
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-5002
  • Fax: 207-878-5007
Mailing address:
  • Phone: 207-878-5002
  • Fax: 207-878-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3042
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: