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General NPI Number Information
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NPI Number | 1508915018
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Entity Type | Individual
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Provider Name | CANDACE M WIGGINS PT
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 4747 MIDDLE SETTLEMENT RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413-4983
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Country | US
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Telephone | 315-793-8580
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Fax | 315-223-4718
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Provider Business Mailing Address
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Address Line | 1 WESTBROOK DR
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City | WHITESBORO
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State | NY
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Zip | 13492-1631
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Country | US
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Telephone | 315-525-2877
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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 | 024327-1
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License Number State | NY
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