Provider Demographics
NPI:1609190966
Name:BICKNELL, SARAH E (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SPINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5794
Mailing Address - Country:US
Mailing Address - Phone:401-459-4008
Mailing Address - Fax:401-459-4010
Practice Address - Street 1:285 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5794
Practice Address - Country:US
Practice Address - Phone:401-459-4008
Practice Address - Fax:401-459-4010
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001538201Medicare PIN