Provider Demographics
NPI:1558750224
Name:FICK, GINA (CFTS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FICK
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N 2ND ST REAR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1564
Mailing Address - Country:US
Mailing Address - Phone:570-523-0822
Mailing Address - Fax:570-523-0847
Practice Address - Street 1:119 N 2ND ST REAR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1564
Practice Address - Country:US
Practice Address - Phone:570-523-0822
Practice Address - Fax:570-523-0847
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA738494000OtherMEDICARE PROVIDER NUMBER