Provider Demographics
NPI:1548076680
Name:HIGDON, DUSTIN MICHAEL (LMT, LMTI, BAAS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:HIGDON
Suffix:
Gender:M
Credentials:LMT, LMTI, BAAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2322
Mailing Address - Country:US
Mailing Address - Phone:512-779-0388
Mailing Address - Fax:
Practice Address - Street 1:641 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2322
Practice Address - Country:US
Practice Address - Phone:512-814-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist