Provider Demographics
NPI:1457426868
Name:HIGGINS, MICHELLE GILMORE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GILMORE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 MOOSE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3260
Mailing Address - Country:US
Mailing Address - Phone:775-787-0957
Mailing Address - Fax:
Practice Address - Street 1:2255 GREEN VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8534
Practice Address - Country:US
Practice Address - Phone:775-673-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist