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Individual

MR. JEFFERSON WIGGINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
24901 NORTHWESTERN HWY, SUITE #113, SOUTHFIELD, MI 48075
(947) 282-8575
(947) 282-8576
Mailing address
PO BOX 1865, DEARBORN, MI 48121
(313) 658-0277
(519) 736-8110

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501006791
MI

Other

Enumeration date
08/14/2008
Last updated
12/29/2015
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