Provider Demographics
NPI:1275727042
Name:PFABE-WIGGANS, SUSAN L (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PFABE-WIGGANS
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 1:310 GLENCOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5757
Mailing Address - Country:US
Mailing Address - Phone:303-355-0372
Mailing Address - Fax:
Practice Address - Street 1:2680 18TH ST
Practice Address - Street 2:SUITE 150A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3994
Practice Address - Country:US
Practice Address - Phone:303-433-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics