Healthcare Provider Details

I. General information

NPI: 1154317337
Provider Name (Legal Business Name): CHARLES R BIGELOW PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 ROWE AVE
WORTHINGTON MN
56187-9700
US

IV. Provider business mailing address

1530 ROWE AVE
WORTHINGTON MN
56187-9700
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-2232
  • Fax: 507-372-7326
Mailing address:
  • Phone: 507-372-2232
  • Fax: 507-372-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2284
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0469
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number483
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03105
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: