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NPI Code Detail

MEDICARE: DR. AMANDA MARY WELLS WIGTON PT, DPT

MEDICARE: DR. AMANDA MARY WELLS WIGTON PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistP13747NC

General Provider Information

NPI Number : 1508111600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA MARY WELLS WIGTON PT, DPT
Provider Business Mailing Address
First Line : 457 DARTMOUTH RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27104-2042
Country : US
Telephone Number : 419-957-8624
Fax Number :
Provider Business Practice Location Address
First Line : 3800 SHAMROCK DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-3220
Country : US
Telephone Number : 704-532-5364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2012
Last Update Date : 01/24/2022

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