Healthcare Provider Details

I. General information

NPI: 1831202936
Provider Name (Legal Business Name): CATHERYNE GENEVIEVE HICKS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C. GENEVIEVE HICKS PT

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356490
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

PO BOX 24366 M/S 359107
SEATTLE WA
98124-0366
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4830
  • Fax: 206-598-4897
Mailing address:
  • Phone: 206-598-8920
  • Fax: 206-598-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00006267
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: