MEDICARE: MANDY LYNN BIXLER PT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-016864	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DO1638265	OTHER	PA	BLUE SHIELD
2	50040652	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1003819160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY LYNN BIXLER PT DPT

Provider Business Mailing Address
First Line	:	48 TUNNEL ROAD
Second Line	:	SUITE 202
City	:	POTTSVILLE
State	:	PA
Zip	:	17901
Country	:	US
Telephone Number	:	570-622-0182
Fax Number	:	570-622-3192

Provider Business Practice Location Address
First Line	:	48 TUNNEL RD
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-3875
Country	:	US
Telephone Number	:	570-622-0182
Fax Number	:	570-622-3192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/16/2009

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