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General NPI Number Information
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NPI Number | 1184281107
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Entity Type | Individual
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Provider Name | SHANNON LEE HIGGINSON DPT
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Gender | Female
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 3845 W 4700 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-3454
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Country | US
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Telephone | 801-840-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 S 1940 E
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City | MILLCREEK
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State | UT
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Zip | 84106-3920
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Country | US
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Telephone | 781-635-5337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11281885-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11281885-2401
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License Number State | UT
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