Provider Demographics
NPI:1457883399
Name:HIGGS, JEROME (DPT)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:HIGGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 MISSION CENTER RD APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4369
Mailing Address - Country:US
Mailing Address - Phone:205-467-8493
Mailing Address - Fax:251-246-5665
Practice Address - Street 1:1711 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2425
Practice Address - Country:US
Practice Address - Phone:251-246-5761
Practice Address - Fax:251-246-5665
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT3052792251X0800X
ALPTH8346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic