MEDICARE: EDWARD HICKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT299	AR

General Provider Information

NPI Number	:	1295360253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD HICKMAN

Provider Business Mailing Address
First Line	:	3721 FREE FERRY RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-1759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11735 OLD HIGHWAY 71 STE 101
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-7023
Country	:	US
Telephone Number	:	479-434-4033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	03/10/2020

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Directions to “ EDWARD HICKMAN ” Practice Location

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