Provider Demographics
NPI:1811438906
Name:WIGGINS, SONNY ALLEN (CP, LP)
Entity type:Individual
Prefix:
First Name:SONNY
Middle Name:ALLEN
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:CP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8998 KIRBY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2830
Mailing Address - Country:US
Mailing Address - Phone:713-432-9949
Mailing Address - Fax:832-925-8728
Practice Address - Street 1:8998 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2830
Practice Address - Country:US
Practice Address - Phone:713-432-9949
Practice Address - Fax:832-925-8728
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1382224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist