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NPI Code Detail

MEDICARE: MRS. ELIZABETH M KIGGINS PT

MEDICARE: MRS. ELIZABETH M KIGGINS PT
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
1225100000XPhysical Therapist021631-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1161303109OTHERNYCIGNA
2161303109OTHERNYUNITED HEALTHCARE
35056028OTHERNYAETNA
4000921744001OTHERNYHEALTHNOW NY
5435613OTHERNYMVP
6000127087OTHERNYBSCNY

General Provider Information

NPI Number : 1780615120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH M KIGGINS PT
Provider Business Mailing Address
First Line : 110 PINE RIDGE RD
Second Line :
City : FAYETTEVILLE
State : NY
Zip : 13066-2239
Country : US
Telephone Number : 315-637-9001
Fax Number :
Provider Business Practice Location Address
First Line : 6034 CARRIER PKWY
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057
Country : US
Telephone Number : 315-432-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 11/04/2009

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