Provider Demographics
NPI:1437398286
Name:ICKES, RICHARD FRANKLIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FRANKLIN
Last Name:ICKES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TIERRA ROSA LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9184
Mailing Address - Country:US
Mailing Address - Phone:530-342-3383
Mailing Address - Fax:
Practice Address - Street 1:7 TIERRA ROSA LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9184
Practice Address - Country:US
Practice Address - Phone:530-342-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant