Healthcare Provider Details

I. General information

NPI: 1417400128
Provider Name (Legal Business Name): ANDREA C BICKFORD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST
MC LEAN VA
22101-3884
US

IV. Provider business mailing address

6829 ELM ST
MC LEAN VA
22101-3884
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax:
Mailing address:
  • Phone: 703-532-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31504
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01802400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number230521197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: