Healthcare Provider Details

I. General information

NPI: 1558750224
Provider Name (Legal Business Name): GINA FICK CFTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 2ND ST REAR
LEWISBURG PA
17837-1564
US

IV. Provider business mailing address

119 N 2ND ST REAR
LEWISBURG PA
17837-1564
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-0822
  • Fax: 570-523-0847
Mailing address:
  • Phone: 570-523-0822
  • Fax: 570-523-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: