Provider Demographics
NPI:1528354446
Name:WIGGINS, JENNIFER (LPTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LAXTON RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2570
Mailing Address - Country:US
Mailing Address - Phone:434-420-0311
Mailing Address - Fax:
Practice Address - Street 1:801 WYNDHURST DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2550
Practice Address - Country:US
Practice Address - Phone:434-237-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602171225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant