Individual provider Active NPI

Jean Hickman, PT

  • Physical Therapist
  • Rutland, VT
National Provider Identifier
1386958502
Registry record updated Jul 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040.0067009 Issued in VT
Practice address
9 Haywood Ave
Rutland, VT 05701-4832
Phone
(802) 775-0007
Fax
(802) 775-3241
NPI assigned
Jul 29, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 197524 NC
Physical Therapist 225100000X 040.0067009 VT Primary
Physical Therapist 225100000X 6189 SC
Physical Therapist 225100000X 7406 NC
Physical Therapist 225100000X PT3672 ME

Addresses

Primary practice location

9 Haywood Ave
Rutland, VT 05701-4832

Mailing address

9 Haywood Ave
Rutland, VT 05701-4832
Phone (802) 775-0007

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

LicenseStateTypeSpecialty
197524NCMDRegistered Nurse
PT3672MEMDPhysical Therapist
6189SCMDPhysical Therapist
040.0067009VTMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1386958502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HAYWOOD AVE",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014832",
            "telephone_number": "802-775-0007",
            "fax_number": "802-775-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HAYWOOD AVE",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014832",
            "telephone_number": "802-775-0007",
            "fax_number": "802-775-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "JEAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "197524",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040.0067009",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "6189",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "7406",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT3672",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.