Individual
GARY D HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1185 W CARMEL DR BLDG C, CARMEL, IN 46032-8708
(317) 582-8924
Mailing address
1185 W CARMEL DR BLDG C, CARMEL, IN 46032-8708
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
05001901A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000222168
ANTHEM GROUP#
IN
05
—
200362000B
—
IN
01
—
5640539
AETNA
IN
Enumeration date
06/22/2006
Last updated
11/14/2016
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