Provider Demographics
NPI:1245222983
Name:HIGBEE, CORY CARTER (PT)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:CARTER
Last Name:HIGBEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1859
Mailing Address - Country:US
Mailing Address - Phone:702-876-1733
Mailing Address - Fax:702-878-2018
Practice Address - Street 1:375 N STEPHANIE ST STE 1111
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8904
Practice Address - Country:US
Practice Address - Phone:702-817-0799
Practice Address - Fax:702-456-0035
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505982Medicaid
NVV100761Medicare PIN