Provider Demographics
NPI:1033486576
Name:HIGLEY, SUSAN R (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:HIGLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 64TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5217
Mailing Address - Country:US
Mailing Address - Phone:727-459-6630
Mailing Address - Fax:
Practice Address - Street 1:7780 49TH ST N # 146
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3440
Practice Address - Country:US
Practice Address - Phone:727-475-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH7097124Q00000X
FLMA41530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No124Q00000XDental ProvidersDental Hygienist