Active NPI
Jennie R Hickin, PT
- Physical Therapist
- Brecksville, OH
National Provider Identifier
1285030304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 012322
- Practice address
- 5913 Fawn LN
Brecksville, OH 44141-2849 - Phone
- (440) 740-1053
- NPI assigned
- Nov 17, 2014
- Last updated
- Nov 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 012322 | OH | Primary |
| Physical Therapist | 225100000X | 020285 | NY |
Addresses
Primary practice location
5913 Fawn LN
Brecksville, OH 44141-2849
Mailing address
5913 Fawn LN
Brecksville, OH 44141-2849
Phone (440) 740-1053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012322 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416182400000",
"number": "1285030304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5913 FAWN LN",
"city": "BRECKSVILLE",
"state": "OH",
"postal_code": "441412849",
"telephone_number": "440-740-1053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5913 FAWN LN",
"city": "BRECKSVILLE",
"state": "OH",
"postal_code": "441412849",
"telephone_number": "440-740-1053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKIN",
"first_name": "JENNIE",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-17",
"last_updated": "2014-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "012322",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "020285",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.