Healthcare Provider Details

I. General information

NPI: 1053395442
Provider Name (Legal Business Name): AMANDA KATHLEEN HIXSON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD KAISER SOUTH SACRAMENTO, REHAB SERVICES
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 BRUCEVILLE RD KAISER SOUTH SACRAMENTO, REHAB SERVICES
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2096
  • Fax: 916-688-6967
Mailing address:
  • Phone: 916-688-2096
  • Fax: 916-688-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: