Provider Demographics
NPI:1396871661
Name:HIGGANUM PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:HIGGANUM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:860-345-2622
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-0619
Mailing Address - Country:US
Mailing Address - Phone:860-345-2622
Mailing Address - Fax:860-345-2626
Practice Address - Street 1:3A CANDLEWOOD HILL ROAD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4202
Practice Address - Country:US
Practice Address - Phone:860-345-2622
Practice Address - Fax:860-345-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080004600CT05OtherANTHEM BCBS
CT080004600CT05OtherANTHEM BCBS
CTDD1387Medicare ID - Type UnspecifiedRAILROAD MEDICARE