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NPI Code Detail

MEDICARE: MR. CARL J. WIGHARDT M.S.P.T.

MEDICARE: MR. CARL J. WIGHARDT M.S.P.T.
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 Therapist16417MA
2225100000XPhysical TherapistQA08473NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
134836379OTHERMAAETNA
2AA19502OTHERMAHARVARD PILGRIM
3Y68196OTHERMABCBS
4NONEOTHERMAUNITED HEALTHCARE
5NO NUMBEROTHERMATRICARE
60030044OTHERMANEIGHBORHOOD HEALTH PLAN
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8NONEOTHERMAGREATWEST HEALTHCARE
9NONEOTHERMAPHCS
10NONEOTHERMAUNICARE
11NONEOTHERMACIGNA

General Provider Information

NPI Number : 1972500544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL J. WIGHARDT M.S.P.T.
Provider Business Mailing Address
First Line : 790 DALE ST
Second Line :
City : NORTH ANDOVER
State : MA
Zip : 01845-1420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 679 S MAIN ST
Second Line :
City : HAVERHILL
State : MA
Zip : 01835-8721
Country : US
Telephone Number : 978-372-3211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 02/12/2014

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