Provider Demographics
NPI:1114645710
Name:HIGGINS, JENNIFER RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-1925
Mailing Address - Country:US
Mailing Address - Phone:605-481-8607
Mailing Address - Fax:
Practice Address - Street 1:745 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2677
Practice Address - Country:US
Practice Address - Phone:605-842-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist