Provider Demographics
NPI:1912578790
Name:HIGGINS, LUCAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 URSULA ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4630
Mailing Address - Country:US
Mailing Address - Phone:207-602-9464
Mailing Address - Fax:
Practice Address - Street 1:105 EDWARDS VILLAGE BLVD
Practice Address - Street 2:SUITE A203
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-926-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5406225100000X
CO0016517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist