Provider Demographics
NPI:1265941728
Name:BIKKERS, SAMUEL J JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:BIKKERS
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BEALE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1403
Mailing Address - Country:US
Mailing Address - Phone:540-598-3960
Mailing Address - Fax:
Practice Address - Street 1:319C MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1381
Practice Address - Country:US
Practice Address - Phone:757-644-1063
Practice Address - Fax:757-644-4129
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist