Provider Demographics
NPI:1114144706
Name:BIGCAS, GAY AMPO (PT)
Entity Type:Individual
Prefix:
First Name:GAY
Middle Name:AMPO
Last Name:BIGCAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAPLE VALLEY DR
Mailing Address - Street 2:APT 1
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1979
Mailing Address - Country:US
Mailing Address - Phone:713-732-9132
Mailing Address - Fax:
Practice Address - Street 1:801 BRIM ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3441
Practice Address - Country:US
Practice Address - Phone:573-431-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist