MEDICARE: CICERO AND HENDRICKS PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1346241072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CICERO AND HENDRICKS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	5535 SWADLY WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 STONE BLVD
Second Line	:	175
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4044
Country	:	US
Telephone Number	:	916-617-2400
Fax Number	:	916-617-2403

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. MICHAEL C CICERO
Credential	:	P.T.
Telephone Number	:	916-617-2400

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	08/22/2020

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