Healthcare Provider Details

I. General information

NPI: 1104508720
Provider Name (Legal Business Name): BAILEY WIGGINS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY DAUGHTRY DPT

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 UNIVERSITY EXEC PARK DR
CHARLOTTE NC
28262-1344
US

IV. Provider business mailing address

2823 GREYSTONE COMMERCIAL BLVD
HOOVER AL
35242-2660
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-1616
  • Fax: 704-759-0799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23964
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11495
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: