Provider Demographics
NPI:1689045312
Name:WIGFALL, ERICKA D (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:D
Last Name:WIGFALL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 OLD WHEAT ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1926
Mailing Address - Country:US
Mailing Address - Phone:615-423-8001
Mailing Address - Fax:
Practice Address - Street 1:100 SPRING HARBOR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4619
Practice Address - Country:US
Practice Address - Phone:706-576-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010312225100000X
FLPT29913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT29913OtherFLORIDA STATE BOARD OF PHYSICAL THERAPY
GAPT010312OtherGEORGIA STATE BOARD OF PHYSICAL THERAPY