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NPI Code Detail

MEDICARE: DR. BRADY WIGGINS DPT

MEDICARE: DR. BRADY WIGGINS DPT
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
1225100000XPhysical Therapist2305209031VA
2225100000XPhysical TherapistP15218NC

General Provider Information

NPI Number : 1659771855
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADY WIGGINS DPT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 300
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-2944
Country : US
Telephone Number : 423-682-8840
Fax Number : 423-602-2028
Provider Business Practice Location Address
First Line : 5619 CAROLINA BEACH RD STE 120
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2815
Country : US
Telephone Number : 910-790-1976
Fax Number : 910-790-1978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2014
Last Update Date : 02/13/2019

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