Provider Demographics
NPI:1780654251
Name:PIGEON, CRAIG S (BS, PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:PIGEON
Suffix:
Gender:M
Credentials:BS, PT
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 967
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-0967
Mailing Address - Country:US
Mailing Address - Phone:509-901-3603
Mailing Address - Fax:509-674-0920
Practice Address - Street 1:105 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1126
Practice Address - Country:US
Practice Address - Phone:509-674-0908
Practice Address - Fax:509-674-0920
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103476Medicaid
WA650020912OtherMEDICARE RAIL ROAD
WA193462600OtherOFFICE WORKERS COMP
WA2134334OtherFIRST HEALTH
WA21870OtherGROUP HEALTH
WA141691OtherLABOR AND INDUSTRIES
WA20137PIOtherREGENCE
WA21870OtherGROUP HEALTH