Provider Demographics
NPI:1083976583
Name:WIGGER, SARAH L (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WIGGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 N NEWBERRY ST # A2105
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-4414
Mailing Address - Country:US
Mailing Address - Phone:316-708-0306
Mailing Address - Fax:
Practice Address - Street 1:3243 E MURDOCK ST # S101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3052
Practice Address - Country:US
Practice Address - Phone:316-687-4581
Practice Address - Fax:316-687-9728
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist