Provider Demographics
NPI:1003006297
Name:HICKS, STEVEN C (MS,ATC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:HICKS
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GUTHRIE SPORTS MEDICINE
Mailing Address - Street 2:ONE GUTHRIE SQUARE
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840
Mailing Address - Country:US
Mailing Address - Phone:570-882-5193
Mailing Address - Fax:570-882-5830
Practice Address - Street 1:GUTHRIE SPORTS MEDICINE
Practice Address - Street 2:ONE GUTHRIE SQUARE
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840
Practice Address - Country:US
Practice Address - Phone:570-882-5193
Practice Address - Fax:570-882-5830
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002057A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer