Healthcare Provider Details

I. General information

NPI: 1295657104
Provider Name (Legal Business Name): BRETT BIGELOW LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 N 93RD AVE STE 105
PEORIA AZ
85381-4260
US

IV. Provider business mailing address

10140 W POTTER DR
PEORIA AZ
85382-2561
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-9360
  • Fax:
Mailing address:
  • Phone: 602-402-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-29091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: