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General NPI Number Information
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NPI Number | 1649710773
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Entity Type | Individual
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Provider Name | TESSA MARIE HICKEY LPTA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 120 BEASLEY DRIVE
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1164
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Country | US
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Telephone | 757-871-4299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1164 120 BEASLEY DRIVE
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1164
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Country | US
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Telephone | 757-871-4299
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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 | PTA 001293
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License Number State | WV
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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 | A2441
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License Number State | MD
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