Provider Demographics
NPI:1972500544
Name:WIGHARDT, CARL J (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:J
Last Name:WIGHARDT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 DALE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:679 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8721
Practice Address - Country:US
Practice Address - Phone:978-372-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16417225100000X
NJQA08473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA34836379OtherAETNA
MAAA19502OtherHARVARD PILGRIM
MAY68196OtherBCBS
MANONEOtherUNITED HEALTHCARE
MANO NUMBEROtherTRICARE
MA0030044OtherNEIGHBORHOOD HEALTH PLAN
MA0326950Medicaid
MANONEOtherGREATWEST HEALTHCARE
MANONEOtherPHCS
MANONEOtherUNICARE
MANONEOtherCIGNA
MAWI 69139Medicare ID - Type Unspecified