Provider Demographics
NPI:1538205083
Name:WIGGINS, RACHEL PENDARVIS (PT, MHS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:PENDARVIS
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-2511
Mailing Address - Country:US
Mailing Address - Phone:803-943-3914
Mailing Address - Fax:803-943-5131
Practice Address - Street 1:103 3RD ST E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-2511
Practice Address - Country:US
Practice Address - Phone:803-943-3914
Practice Address - Fax:803-943-5131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2308174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2068Medicaid
SCTH0722Medicaid
SCTH0722Medicaid