Provider Demographics
NPI:1174538953
Name:WIGGAN, MARILYN (MSPT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:WIGGAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 75TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2308
Mailing Address - Country:US
Mailing Address - Phone:630-985-4700
Mailing Address - Fax:630-985-4523
Practice Address - Street 1:2007 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2308
Practice Address - Country:US
Practice Address - Phone:630-985-4700
Practice Address - Fax:630-985-4523
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist