MEDICARE: AMANDA BICKFORD

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	225200000X	Physical Therapy Assistant		IN
2	2255A2300X	Athletic Trainer		IN

General Provider Information

NPI Number	:	1477307031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BICKFORD

Provider Business Mailing Address
First Line	:	3644 E COUNTY ROAD 1600 N
Second Line	:
City	:	LINCOLN CITY
State	:	IN
Zip	:	47552-9662
Country	:	US
Telephone Number	:	812-937-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3644 E COUNTY ROAD 1600 N
Second Line	:
City	:	LINCOLN CITY
State	:	IN
Zip	:	47552-9662
Country	:	US
Telephone Number	:	812-937-2400
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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Directions to “ AMANDA BICKFORD ” Practice Location

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