Individual
MR. KEVIN HOWARD HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1104 E GRACE ST, JASPER COUNTY HOSPITAL, RENSSELAER, IN 47978-3211
(219) 866-5141
(219) 866-3234
Mailing address
1104 E GRACE ST, RENSSELAER, IN 47978-3211
(219) 866-5141
(219) 866-3234
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05005503A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200307390
—
IN
Enumeration date
05/23/2006
Last updated
10/13/2010
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