Provider Demographics
NPI:1154963460
Name:HIGGINS, KALI (PTA)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 N SOCORA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3288
Mailing Address - Country:US
Mailing Address - Phone:316-462-7430
Mailing Address - Fax:316-729-0021
Practice Address - Street 1:854 N SOCORA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3288
Practice Address - Country:US
Practice Address - Phone:316-462-7430
Practice Address - Fax:316-729-0021
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03574225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant