| NPI | 1194166116 |
|---|---|
| Former Name | CARISSA MICHELLE WIGAND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2013023363) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2019-01-23 |