Provider Demographics
NPI:1154317337
Name:BIGELOW, CHARLES R (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ROWE AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-9700
Mailing Address - Country:US
Mailing Address - Phone:507-372-2232
Mailing Address - Fax:507-372-7326
Practice Address - Street 1:1530 ROWE AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-9700
Practice Address - Country:US
Practice Address - Phone:507-372-2232
Practice Address - Fax:507-372-7326
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2284225100000X
SD0469225100000X
ND483225100000X
IA03105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN25806OtherARAZ
SD5830113Medicaid
SD25806OtherARAZ
SD5830115Medicaid
MN64-08038OtherMEDICA
MN23143OtherSIOUX VALLEY HEALTH PLANS
SD64-08036OtherMEDICA
SD8B711BIOtherBLUE CROSS BLUE SHIELD MN
SD4998544OtherBLUE CROSS BLUE SHIELD SD
MN64-05334OtherMEDICA
MN8B711BIOtherBLUE CROSS BLUE SHIELD MN
MN0469.1OtherDAKOTACARE
SD5830112Medicaid
MN64-03580OtherMEDICA
SD0469.1OtherDAKOTACARE
MN64-04224OtherMEDICA
SD64-08037OtherMEDICA
SD64-04206OtherMEDICA
MN3110OtherAVERA HEALTH PLANS
MN64-03864OtherMEDICA