Provider Demographics
NPI:1780615120
Name:KIGGINS, ELIZABETH M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:KIGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2239
Mailing Address - Country:US
Mailing Address - Phone:315-637-9001
Mailing Address - Fax:
Practice Address - Street 1:6034 CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-432-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021631-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161303109OtherCIGNA
NY161303109OtherUNITED HEALTHCARE
NY5056028OtherAETNA
NY000921744001OtherHEALTHNOW NY
NY435613OtherMVP
NY000127087OtherBSCNY
NY435613OtherMVP