MEDICARE: SUSAN L PFABE-WIGGANS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	2827	CO

General Provider Information

NPI Number	:	1275727042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L PFABE-WIGGANS P.T.

Provider Business Mailing Address
First Line	:	310 GLENCOE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-5757
Country	:	US
Telephone Number	:	303-355-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 18TH ST
Second Line	:	SUITE 150A
City	:	DENVER
State	:	CO
Zip	:	80211-3994
Country	:	US
Telephone Number	:	303-433-0852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	09/05/2007

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