Provider Demographics
NPI:1881934388
Name:WIGHTMAN, KIRSTEN I (PT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:I
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:408-733-4380
Mailing Address - Fax:650-691-6193
Practice Address - Street 1:582 S SUNNYVALE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6125
Practice Address - Country:US
Practice Address - Phone:408-733-4380
Practice Address - Fax:919-620-4921
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13796225100000X
CAPT40643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist