Healthcare Provider Details

I. General information

NPI: 1093716946
Provider Name (Legal Business Name): CICERO AND HENDRICKS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S LAND PARK DR 300
SACRAMENTO CA
95831-3612
US

IV. Provider business mailing address

5535 SWADLY WAY
SACRAMENTO CA
95835-1520
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-5010
  • Fax: 916-391-5017
Mailing address:
  • Phone: 916-391-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL C CICERO
Title or Position: PARTNER
Credential: P.T.
Phone: 916-391-5010