=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598975591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ANDREW BIXLER MSPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 E NORWEGIAN ST
-----------------------------------------------------
City | POTTSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17901-2710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-621-4256
-----------------------------------------------------
Fax | 570-621-4068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 167 ROLLING VIEW DR
-----------------------------------------------------
City | SCHUYLKILL HAVEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17972-8867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT016352
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------