Healthcare Provider Details

I. General information

NPI: 1487034013
Provider Name (Legal Business Name): TY BIGELOW DAT, MBA, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E LANCASTER AVE
VILLANOVA PA
19085-1603
US

IV. Provider business mailing address

800 E LANCASTER AVE
VILLANOVA PA
19085-1603
US

V. Phone/Fax

Practice location:
  • Phone: 610-519-6420
  • Fax:
Mailing address:
  • Phone: 610-519-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: