Healthcare Provider Details

I. General information

NPI: 1053276477
Provider Name (Legal Business Name): MARY L BIXLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 DAVENPORT BLVD
DAVENPORT FL
33837-9201
US

IV. Provider business mailing address

1991 DAVENPORT BLVD
DAVENPORT FL
33837-9201
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-3338
  • Fax: 863-455-7049
Mailing address:
  • Phone: 863-679-3338
  • Fax: 863-455-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA18842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: