Basic Information
Provider Information
NPI: 1982714606
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HICSWA
FirstName: RONALD
MiddleName: KEVIN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Practice Location
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Other Information
ProviderEnumerationDate: 08/30/2006
LastUpdateDate: 12/22/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
40QA0090000001NJLICENSEOTHER
PT01832301PASTATE PT LICENSEOTHER
926120801 AETNA PPOOTHER
203821201 UNITED HEALTHCAREOTHER
5008123101 CAPITAL BLUE CROSSOTHER
668799301 AETNA HMOOTHER
227424400001 KEYSTONE HEALTH PLAN EASTOTHER
227424400001 AMERIHEALTHOTHER
4724101 GEISINGER HEALTH PLANOTHER
207065701 HIGHMARK BLUE SHIELDOTHER
227424400001 INDEPENDENCE BLUE CROSSOTHER
156638101 GATEWAY HEALTH PLANOTHER
5008123101 KEYSTONE HEALTH PLAN CENTRALOTHER


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