Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 36588 | CA |
N | 226300000X | Kinesiotherapist | 36588 | CA |
NPI | 1679892020 |
---|---|
Provider Name | Dawn Marie Higgins |
First Address | Murrieta, CA 92562-6177 |
Second Address | Escondido, CA 92025-3431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36588 | PHYSICAL THERAPY BOARD OF CALIFORNIA (01) | CA |