Healthcare Provider Details

I. General information

NPI: 1023076445
Provider Name (Legal Business Name): ERNESTINE HIGDON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 301 NORTH B ST US DHHS INDIAN HEALTH SERVICE
ZUNI NM
87327-0467
US

IV. Provider business mailing address

PO BOX 467
ZUNI NM
87327-0467
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-4431
  • Fax: 505-782-7551
Mailing address:
  • Phone: 505-782-4431
  • Fax: 505-782-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number281
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: