Provider Demographics
NPI:1467695551
Name:DWIGHT-HIGGIN, TYESHA MONIQUE (DPT)
Entity Type:Individual
Prefix:
First Name:TYESHA
Middle Name:MONIQUE
Last Name:DWIGHT-HIGGIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:TYESHA
Other - Middle Name:MONIQUE
Other - Last Name:DWIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4003
Mailing Address - Country:US
Mailing Address - Phone:973-941-7327
Mailing Address - Fax:
Practice Address - Street 1:801 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2544
Practice Address - Country:US
Practice Address - Phone:973-941-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1467695551Medicaid
DE295855OtherUNISON
DE3747012000OtherIBC
DEP00897518OtherRAILROAD MEDICARE
DE1467695551OtherDPCI
DE155154ZB82Medicare PIN