Provider Demographics
NPI:1174888457
Name:BICKERT, PHILIP ANTHONY (CP)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:BICKERT
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2463
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-2463
Mailing Address - Country:US
Mailing Address - Phone:662-795-4555
Mailing Address - Fax:662-643-4131
Practice Address - Street 1:2106S TATE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7913
Practice Address - Country:US
Practice Address - Phone:662-795-4555
Practice Address - Fax:662-643-4131
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO000000184224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist