Provider Demographics
NPI:1194800250
Name:HIGDON, SOMER NICOLE (DPT, MOT)
Entity type:Individual
Prefix:MISS
First Name:SOMER
Middle Name:NICOLE
Last Name:HIGDON
Suffix:
Gender:F
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S NARDO AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2327
Mailing Address - Country:US
Mailing Address - Phone:970-481-7377
Mailing Address - Fax:
Practice Address - Street 1:695 S NARDO AVE
Practice Address - Street 2:G4
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2327
Practice Address - Country:US
Practice Address - Phone:970-481-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9257225100000X, 2251G0304X, 2251S0007X, 2251X0800X
CO1074264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1074264OtherOT CERTIFICATION
CO9257OtherPT LICENSE