Provider Demographics
NPI:1811202559
Name:WIGGS, KELSEY PAIGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:PAIGE
Last Name:WIGGS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:PAIGE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23269
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3269
Mailing Address - Country:US
Mailing Address - Phone:254-399-8255
Mailing Address - Fax:254-235-3408
Practice Address - Street 1:601 W LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6840
Practice Address - Country:US
Practice Address - Phone:254-399-8255
Practice Address - Fax:254-235-3408
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist