Provider Demographics
NPI:1285203885
Name:VIVLAMORE ZION HIGGINS, CHEYENNE CASSIDY (DPT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CASSIDY
Last Name:VIVLAMORE ZION HIGGINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2535
Mailing Address - Country:US
Mailing Address - Phone:315-591-5873
Mailing Address - Fax:
Practice Address - Street 1:160 W 4TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2535
Practice Address - Country:US
Practice Address - Phone:315-591-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047319261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy