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Individual
MR. RANDY SCOTT HICKS
Active
Individual
MR. RANDY SCOTT HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
CA-PT29992
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT299920
BLUE SHIELD
CA
01
—
DA6172
MEDICARE RAILROAD GROUP #
CA
01
—
P00459387
MEDICARE RAILROAD IND. #
CA
Enumeration date
10/10/2006
Last updated
05/27/2008
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