Healthcare Provider Details

I. General information

NPI: 1457426868
Provider Name (Legal Business Name): MICHELLE GILMORE HIGGINS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 GREEN VISTA DR
SPARKS NV
89431-8534
US

IV. Provider business mailing address

2944 MOOSE RIDGE DR
RENO NV
89523-3260
US

V. Phone/Fax

Practice location:
  • Phone: 775-673-9700
  • Fax:
Mailing address:
  • Phone: 775-787-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1211
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: