Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 019443-1 | NY |
NPI | 1699911560 |
---|---|
Provider Name | Jason Wayne Bigelow |
First Address | Binghamton, NY 13903-1617 |
Second Address | Binghamton, NY 13903-1617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2008 |
Last Update Date | 26/12/2008 |