MEDICARE: MRS. ALICE SUSAN HIGGINS P.T.A.

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	225200000X	Physical Therapy Assistant	002634-1	NY

General Provider Information

NPI Number	:	1679652374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICE SUSAN HIGGINS P.T.A.

Provider Business Mailing Address
First Line	:	42 PACE DR
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-5315
Country	:	US
Telephone Number	:	631-422-6908
Fax Number	:	516-798-9070

Provider Business Practice Location Address
First Line	:	4200 SUNRISE HWY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5303
Country	:	US
Telephone Number	:	516-541-1064
Fax Number	:	516-798-9070

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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