Provider Demographics
NPI:1629217096
Name:WIGGINS, SHEMENA MONIQUE (PT)
Entity type:Individual
Prefix:MS
First Name:SHEMENA
Middle Name:MONIQUE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 LAWNDALE DR.
Mailing Address - Street 2:LOYALTON OF GREENSBORO
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-286-7076
Mailing Address - Fax:336-286-7077
Practice Address - Street 1:3823 LAWNDALE DR.
Practice Address - Street 2:LOYALTON OF GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455
Practice Address - Country:US
Practice Address - Phone:336-286-7076
Practice Address - Fax:336-286-7076
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist