Provider Demographics
NPI:1093716946
Name:CICERO AND HENDRICKS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CICERO AND HENDRICKS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-391-5010
Mailing Address - Street 1:5535 SWADLY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1520
Mailing Address - Country:US
Mailing Address - Phone:916-391-5010
Mailing Address - Fax:
Practice Address - Street 1:7200 S LAND PARK DR
Practice Address - Street 2:300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3612
Practice Address - Country:US
Practice Address - Phone:916-391-5010
Practice Address - Fax:916-391-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21147ZMedicare ID - Type UnspecifiedGROUP MEDICARE ID