Provider Demographics
NPI:1164810131
Name:HICKEY, CHERYL JULIE (MPT, MS, EDD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JULIE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MPT, MS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E SAN RAMON AVE
Mailing Address - Street 2:MS MH 29
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93740-8031
Mailing Address - Country:US
Mailing Address - Phone:559-278-3030
Mailing Address - Fax:559-278-3635
Practice Address - Street 1:7265 N 1ST ST
Practice Address - Street 2:#105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2956
Practice Address - Country:US
Practice Address - Phone:559-431-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist