Individual
HEATH HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
4442 CEDAR BUTTE CIR, REXBURG, ID 83440-4320
(208) 351-0340
Mailing address
4442 CEDAR BUTTE CIR, REXBURG, ID 83440-4320
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-343
ID
Other
Enumeration date
01/21/2014
Last updated
01/21/2014
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