Basic Information
| Provider Information | |||||||||
| NPI: | 1467695551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DWIGHT-HIGGIN | ||||||||
| FirstName: | TYESHA | ||||||||
| MiddleName: | MONIQUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DWIGHT | ||||||||
| OtherFirstName: | TYESHA | ||||||||
| OtherMiddleName: | MONIQUE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651-53 PULASKI HIGHWAY | ||||||||
| Address2: | SALEM CENTER | ||||||||
| City: | BEAR | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028341550 | ||||||||
| FaxNumber: | 3028341549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J10002457 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1467695551 | 05 | DE | MEDICAID | 295855 | 01 | DE | UNISON | OTHER | 3747012000 | 01 | DE | IBC | OTHER | P00897518 | 01 | DE | RAILROAD MEDICARE | OTHER | 1467695551 | 01 | DE | DPCI | OTHER |