Provider Demographics
NPI:1255561684
Name:HIGGINS, BRANDY DAWN (PTA)
Entity type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:DAWN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1035
Mailing Address - Country:US
Mailing Address - Phone:304-927-1007
Mailing Address - Fax:304-927-5830
Practice Address - Street 1:825 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1035
Practice Address - Country:US
Practice Address - Phone:304-927-1007
Practice Address - Fax:304-927-5830
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1486225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant