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General NPI Number Information
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NPI Number | 1558018580
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Entity Type | Individual
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Provider Name | SAMANTHA HICKEY
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 3030 WATERVIEW PKWY FL 1
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City | RICHARDSON
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State | TX
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Zip | 75080-1400
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Country | US
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Telephone | 972-669-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 469-426-7410
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Fax | 214-645-0078
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1356969
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License Number State | TX
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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 | 1356969
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License Number State | TX
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