Basic Information
| Provider Information | |||||||||
| NPI: | 1982714606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICSWA | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | KEVIN | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 50081231 | 01 | CAPITAL BLUE CROSS | OTHER | 2070657 | 01 | HIGHMARK BLUE SHIELD | OTHER | 2038212 | 01 | UNITED HEALTHCARE | OTHER | 47241 | 01 | GEISINGER HEALTH PLAN | OTHER | PT018323 | 01 | PA | STATE PT LICENSE | OTHER | 2274244000 | 01 | AMERIHEALTH | OTHER | 9261208 | 01 | AETNA PPO | OTHER | 1566381 | 01 | GATEWAY HEALTH PLAN | OTHER | 6687993 | 01 | AETNA HMO | OTHER | 40QA00900000 | 01 | NJ | LICENSE | OTHER | 2274244000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 2274244000 | 01 | KEYSTONE HEALTH PLAN EAST | OTHER | 50081231 | 01 | KEYSTONE HEALTH PLAN CENTRAL | OTHER |