Healthcare Provider Details

I. General information

NPI: 1922969328
Provider Name (Legal Business Name): LEVI WIGGINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-5445
  • Fax: 859-353-5601
Mailing address:
  • Phone: 859-353-5445
  • Fax: 859-353-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number009507
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: