MEDICARE: MS. ALICE G HIGGINS LMBT,NMT,MMT,PPMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	4319	NC

General Provider Information

NPI Number	:	1477862456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE G HIGGINS LMBT,NMT,MMT,PPMT

Provider Business Mailing Address
First Line	:	4801 HARGROVE RD
Second Line	:	SUITE 106-A
City	:	RALEIGH
State	:	NC
Zip	:	27616-1945
Country	:	US
Telephone Number	:	919-649-7323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HARGROVE RD
Second Line	:	SUITE 106-A
City	:	RALEIGH
State	:	NC
Zip	:	27616-1945
Country	:	US
Telephone Number	:	919-649-7323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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