Provider Demographics
NPI:1104331180
Name:HIETT, MICAH DANIEL
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:DANIEL
Last Name:HIETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 AVENUE 410
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9712
Mailing Address - Country:US
Mailing Address - Phone:559-393-9941
Mailing Address - Fax:
Practice Address - Street 1:1128 S REED AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3726
Practice Address - Country:US
Practice Address - Phone:559-638-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer