Provider Demographics
NPI:1063471142
Name:BIGGERSTAFF, RANDY LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEE
Last Name:BIGGERSTAFF
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:200 FORD STREET
Mailing Address - City:GRAY SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:63039-0006
Mailing Address - Country:US
Mailing Address - Phone:636-742-2738
Mailing Address - Fax:636-949-4636
Practice Address - Street 1:209 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1693
Practice Address - Country:US
Practice Address - Phone:636-949-4683
Practice Address - Fax:636-949-4636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer