Provider Demographics
NPI:1568050268
Name:HIGGS, SEAN (ATC, PTA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:HIGGS
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5538
Mailing Address - Country:US
Mailing Address - Phone:949-280-7798
Mailing Address - Fax:
Practice Address - Street 1:1700 STADIUM WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1404
Practice Address - Country:US
Practice Address - Phone:213-392-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer