Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2112883 | TX |
NPI | 1013406545 |
---|---|
Provider Name | Matthew Hicks |
First Address | Flint, TX 75762-3430 |
Second Address | Flint, TX 75762-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |