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General NPI Number Information
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NPI Number | 1548515000
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Entity Type | Individual
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Provider Name | HEIDI SULICK PTA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 3 OLD BRIDGE DR
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City | POOLER
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State | GA
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Zip | 31322-4906
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Country | US
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Telephone | 912-450-6203
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Fax |
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Provider Business Mailing Address
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Address Line | 3 OLD BRIDGE DR
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City | POOLER
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State | GA
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Zip | 31322-4906
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Country | US
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Telephone | 912-450-6203
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2261
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1917
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2291
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2033959
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1914
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License Number State | LA
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Taxonomy #6
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1450
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | H2036
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License Number State | MD
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Taxonomy #8
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 23361
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License Number State | FL
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