Healthcare Provider Details

I. General information

NPI: 1679401863
Provider Name (Legal Business Name): ALEXANDER MICHAEL HICKMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ASTORIA RD
GERMANTOWN OH
45327-1712
US

IV. Provider business mailing address

5870 BROOKE MEADOWS CT
FAIRFIELD TOWNSHIP OH
45011-8517
US

V. Phone/Fax

Practice location:
  • Phone: 937-855-2363
  • Fax:
Mailing address:
  • Phone: 513-207-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA013423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: