Provider Demographics
NPI:1396836755
Name:BIGWOOD, CONNIE LYNN MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LYNN MARIE
Last Name:BIGWOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:LYNN MARIE
Other - Last Name:REAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 MANARDA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023
Mailing Address - Country:US
Mailing Address - Phone:404-697-0399
Mailing Address - Fax:
Practice Address - Street 1:765 MANARDA CIRCLE
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023
Practice Address - Country:US
Practice Address - Phone:404-697-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT7887225100000X
NC11397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDVBMedicare ID - Type UnspecifiedPART B PROVIDER BILLING