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General NPI Number Information
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NPI Number | 1477511525
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Entity Type | Individual
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Provider Name | ELIZABETH JOHNSON HICKS PT
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Gender | Female
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 37 S MAIN ST
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City | WILLISTON
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State | FL
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Zip | 32696-2681
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Country | US
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Telephone | 352-528-0022
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Fax | 352-528-2878
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Provider Business Mailing Address
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Address Line | 21645 NW 87TH AVENUE RD
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City | MICANOPY
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State | FL
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Zip | 32667-7430
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Country | US
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Telephone | 352-466-0130
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Fax | 352-529-0014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 36
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5183
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN1487192
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License Number State | FL
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