Healthcare Provider Details

I. General information

NPI: 1053125443
Provider Name (Legal Business Name): MAURA EILEEN HICKEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST SUITE 203
DURHAM NC
27704
US

IV. Provider business mailing address

2609 N DUKE ST SUITE 203
DURHAM NC
27704
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-6532
  • Fax:
Mailing address:
  • Phone: 919-220-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP052851T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16782
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055940T
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30303
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP050420T
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033025
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: