Basic Information
| Provider Information | |||||||||
| NPI: | 1164810131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICKEY | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | JULIE | ||||||||
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| Credential: | MPT, MS, EDD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2345 E SAN RAMON AVE | ||||||||
| Address2: | MS MH 29 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937408031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592783030 | ||||||||
| FaxNumber: | 5592783635 | ||||||||
| Practice Location | |||||||||
| Address1: | 7265 N 1ST ST | ||||||||
| Address2: | #105 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594318181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2014 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT21517 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.