Provider Demographics
NPI:1982714606
Name:HICSWA, RONALD KEVIN
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KEVIN
Last Name:HICSWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50081231OtherCAPITAL BLUE CROSS
2070657OtherHIGHMARK BLUE SHIELD
2038212OtherUNITED HEALTHCARE
47241OtherGEISINGER HEALTH PLAN
PAPT018323OtherSTATE PT LICENSE
2274244000OtherAMERIHEALTH
9261208OtherAETNA PPO
1566381OtherGATEWAY HEALTH PLAN
6687993OtherAETNA HMO
NJ40QA00900000OtherLICENSE
2274244000OtherINDEPENDENCE BLUE CROSS
2274244000OtherKEYSTONE HEALTH PLAN EAST
50081231OtherKEYSTONE HEALTH PLAN CENTRAL
50081231OtherKEYSTONE HEALTH PLAN CENTRAL