Provider Demographics
NPI:1952363111
Name:HICKMAN, ROBERT H JR (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:HICKMAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9404 GENESEE AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1339
Mailing Address - Country:US
Mailing Address - Phone:858-455-1195
Mailing Address - Fax:858-455-7101
Practice Address - Street 1:1679 E MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5212
Practice Address - Country:US
Practice Address - Phone:619-444-1462
Practice Address - Fax:619-444-1478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT240092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT24009CMedicare ID - Type Unspecified
WPT24009BMedicare ID - Type Unspecified