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General NPI Number Information
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NPI Number | 1821672312
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Entity Type | Individual
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Provider Name | NICOLE WIGHAM DPT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 26 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-8620
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Country | US
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Telephone | 617-828-5617
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Fax |
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Provider Business Mailing Address
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Address Line | 99 WASHINGTON ST UNIT 338
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City | MELROSE
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State | MA
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Zip | 02176-6088
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Country | US
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Telephone | 978-478-7793
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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 | 23901
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License Number State | MA
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