Individual
ANDREW WIGGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
900 MAIN ST, SUITE 450, PEORIA, IL 61602-1005
(309) 672-4568
(309) 672-4569
Mailing address
900 MAIN ST, SUITE 450, PEORIA, IL 61602-1005
(309) 672-4568
(309) 672-4569
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01162435
RR MEDICARE
IL
Enumeration date
06/12/2008
Last updated
06/04/2013
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