Provider Demographics
NPI:1235531757
Name:BICKEL, ROBERT CRAIG
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CRAIG
Last Name:BICKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7824
Mailing Address - Country:US
Mailing Address - Phone:410-828-1407
Mailing Address - Fax:
Practice Address - Street 1:639 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7824
Practice Address - Country:US
Practice Address - Phone:410-828-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist