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General NPI Number Information
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NPI Number | 1619490802
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Entity Type | Individual
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Provider Name | DANIELLE MARIE HICKS LMT
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Gender | Female
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE STE 108
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City | GLENDALE
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State | AZ
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Zip | 85308-5665
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Country | US
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Telephone | 602-668-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 6428 W GARDEN DR
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City | GLENDALE
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State | AZ
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Zip | 85304-3660
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Country | US
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Telephone | 602-668-4723
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-23195
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License Number State | AZ
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