Provider Demographics
NPI:1184941650
Name:HIGGINS, JESSICA LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:WHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:540 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9540
Mailing Address - Country:US
Mailing Address - Phone:503-845-2736
Mailing Address - Fax:503-845-9229
Practice Address - Street 1:540 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9540
Practice Address - Country:US
Practice Address - Phone:503-845-2736
Practice Address - Fax:503-845-9229
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist