Provider Demographics
NPI:1487034013
Name:BIGELOW, TY (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1603
Mailing Address - Country:US
Mailing Address - Phone:610-519-6420
Mailing Address - Fax:
Practice Address - Street 1:800 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-519-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer