Healthcare Provider Details

I. General information

NPI: 1275727042
Provider Name (Legal Business Name): SUSAN L PFABE-WIGGANS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 18TH ST SUITE 150A
DENVER CO
80211-3994
US

IV. Provider business mailing address

310 GLENCOE ST
DENVER CO
80220-5757
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-0852
  • Fax:
Mailing address:
  • Phone: 303-355-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2827
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: