Healthcare Provider Details

I. General information

NPI: 1538518808
Provider Name (Legal Business Name): CHRISTEN BICKERSTAFF PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SOUTH PARK BLVD. SUITE 100
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1478
  • Fax: 904-824-8071
Mailing address:
  • Phone: 904-345-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: