Most Relevant Information
Provider Data
| NPI Number: | 1003545617 |
| Provider Name: | GLEN EDWARD HIGGINBOTHAM MA |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 012564 |
Most Important Dates
| Enumeration Date: | 06/08/2022 |
| Last Updated: | 06/08/2022 |
Provider Practice Location
17273 STATE ROUTE 104
CHILLICOTHE
OH
456019718
Practice Location Phone/Fax
| Phone: | 7409931210 |
| Fax: |
Provider Mailing Location
17273 STATE ROUTE 104
CHILLICOTHE
OH
456019718
Provider Mailing Phone/Fax
| Phone: | 7409931210 |
| Fax: |