Provider Demographics
NPI:1386006229
Name:LYKINS, CHAD EDGAR
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:EDGAR
Last Name:LYKINS
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 1:750 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2313
Mailing Address - Country:US
Mailing Address - Phone:765-939-0820
Mailing Address - Fax:765-939-0920
Practice Address - Street 1:750 N 10TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2313
Practice Address - Country:US
Practice Address - Phone:765-939-0820
Practice Address - Fax:765-939-0920
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003757A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant