Healthcare Provider Details

I. General information

NPI: 1467701243
Provider Name (Legal Business Name): HALLIE B. SIKES MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W. MAIN ST.
ALBEMARLE NC
28001-2555
US

IV. Provider business mailing address

217 W MAIN ST
ALBEMARLE NC
28001-4816
US

V. Phone/Fax

Practice location:
  • Phone: 704-269-8405
  • Fax: 877-991-8478
Mailing address:
  • Phone: 704-269-8405
  • Fax: 877-991-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9888
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: