Provider Demographics
NPI:1003819160
Name:BIXLER, MANDY LYNN (PT DPT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:BIXLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 TUNNEL ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901
Mailing Address - Country:US
Mailing Address - Phone:570-622-0182
Mailing Address - Fax:570-622-3192
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-0182
Practice Address - Fax:570-622-3192
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-016864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADO1638265OtherBLUE SHIELD
PA50040652OtherCAPITAL BLUE CROSS
PAQ21191Medicare UPIN