Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9257 | CO |
N | 2251G0304X | Physical Therapist - Geriatrics | 9257 | CO |
N | 2251S0007X | Physical Therapist - Sports | 9257 | CO |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9257 | CO |
N | 225X00000X | Occupational Therapist | 1074264 | CO |
NPI | 1194800250 |
---|---|
Provider Name | Miss Somer Nicole Higdon |
First Address | Solana Beach, CA 92075-2327 |
Second Address | Solana Beach, CA 92075-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 27/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1074264 | OT CERTIFICATION (01) | CO |
9257 | PT LICENSE (01) | CO |