Healthcare Provider Details

I. General information

NPI: 1356639199
Provider Name (Legal Business Name): JORDAN P HICKS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 400
NASHVILLE TN
37205-4900
US

IV. Provider business mailing address

800 CRESCENT CENTRE DR STE 600
FRANKLIN TN
37067-7286
US

V. Phone/Fax

Practice location:
  • Phone: 615-921-6504
  • Fax: 615-921-6505
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: