Provider Demographics
NPI:1013249200
Name:HIGGINBOTHAM, GARY RICHARD II (MSPT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:RICHARD
Last Name:HIGGINBOTHAM
Suffix:II
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:506 BARTON CT
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BLUE RIDGE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-7261
Practice Address - Country:US
Practice Address - Phone:276-632-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10052225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist