Provider Demographics
NPI:1790314847
Name:HICKEY, CYLE DRAKE (PT)
Entity Type:Individual
Prefix:
First Name:CYLE
Middle Name:DRAKE
Last Name:HICKEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-1612
Mailing Address - Country:US
Mailing Address - Phone:254-749-6325
Mailing Address - Fax:
Practice Address - Street 1:709 PARK ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-1612
Practice Address - Country:US
Practice Address - Phone:254-749-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1328199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist