Kevin Howard Hicks, PT
Individual provider Active NPI Physical Therapist · Rensselaer, IN
NPI 1851346597 · NPPES record last updated Oct 13, 2010
Key facts
- NPI
- 1851346597
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05005503A (IN)
- Practice address
- 1104 E Grace St
Jasper County Hospital
Rensselaer, IN 47978-3211 - Phone
- (219) 866-5141
- Fax
- (219) 866-3234
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05005503A | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chattanooga Spine & Sport | Physical Therapist | Past | Accepting new patients |
| Agilitas USA, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05005503A | IN | Yes |
Addresses
Primary practice location
1104 E Grace St
Jasper County Hospital
Rensselaer, IN 47978-3211
Mailing address
1104 E Grace St
Rensselaer, IN 47978-3211
Phone (219) 866-5141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200307390 | Medicaid | IN |
Other providers in Rensselaer, IN
- Deanna Lynn Hannon
- Erin Marie Hardebeck
- Head and Neck Diagnostic Associates, P.C.
- Hendricks County Hospital
- Kenneth Riley Hickman
- Rhonda Lyn Hicks
- Hillcrest Family Dental Center , P.C.
- Hook-Superx LLC
- Janet Hord
- Harley Edmund Houghton
All providers in Rensselaer, IN · Physical Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.