Healthcare Provider Details

I. General information

NPI: 1073507109
Provider Name (Legal Business Name): RICHARD FIKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

IV. Provider business mailing address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-3473
  • Fax: 916-487-3483
Mailing address:
  • Phone: 916-487-3473
  • Fax: 916-487-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: