Provider Demographics
NPI:1437355138
Name:WIGHT, MARY HELEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HELEN
Last Name:WIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14145 ROCKY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38581-7007
Mailing Address - Country:US
Mailing Address - Phone:931-686-2661
Mailing Address - Fax:931-686-8775
Practice Address - Street 1:14145 ROCKY RIVER RD
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:TN
Practice Address - Zip Code:38581-7007
Practice Address - Country:US
Practice Address - Phone:931-686-2661
Practice Address - Fax:931-686-8775
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist