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General NPI Number Information
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NPI Number | 1508111600
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Entity Type | Individual
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Provider Name | AMANDA MARY WELLS WIGTON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 3800 SHAMROCK DR
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City | CHARLOTTE
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State | NC
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Zip | 28215-3220
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Country | US
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Telephone | 704-532-5364
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Fax |
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Provider Business Mailing Address
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Address Line | 457 DARTMOUTH RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-2042
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Country | US
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Telephone | 419-957-8624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P13747
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License Number State | NC
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