{
"Npi": {
"NPI": "1053675744",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HICKS",
"FirstName": "HOLLY",
"MiddleName": "MARIE",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "P.T.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2509 IROQUOIS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OWENSBORO",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42301-5320",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-569-4808",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2509 IROQUOIS DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OWENSBORO",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "42301-5320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-569-4808",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2012",
"LastUpdateDate": "11/21/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "1934",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "CPO37353T",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "006349",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}