Provider Demographics
NPI:1063429819
Name:HICKS, JARROD DON (MPT)
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:DON
Last Name:HICKS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W BULLARD AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-299-0344
Mailing Address - Fax:559-299-0391
Practice Address - Street 1:255 W BULLARD AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-299-0344
Practice Address - Fax:559-299-0391
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT32627Medicare UPIN