Provider Demographics
NPI:1871241133
Name:BICKHAM, KATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 FALCONER DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8204
Mailing Address - Country:US
Mailing Address - Phone:985-893-2845
Mailing Address - Fax:985-893-2654
Practice Address - Street 1:2565 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3566
Practice Address - Country:US
Practice Address - Phone:985-626-6066
Practice Address - Fax:985-626-6966
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist