Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 8965 | NC |
N | 2251N0400X | Physical Therapist - Neurology | PT 00009970 | WA |
NPI | 1326354085 |
---|---|
Provider Name | Amanda Wiggins |
First Address | Sanford, NC 27330-7713 |
Second Address | Southern Pines, NC 28387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2010 |
Last Update Date | 16/10/2018 |