Individual
RUSSELL ALAN WIGLESWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
15455 S ROGERS RD, OLATHE, KS 66062-3497
(913) 254-0568
(913) 254-0854
Mailing address
PO BOX 219297, KANSAS CITY, MO 64121-9297
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-00821
KS
225100000X
Physical Therapist
R0956
MO
Other
Enumeration date
05/20/2006
Last updated
06/16/2021
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