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NPI Code Detail

MEDICARE: SHAILAH HICKS PTA

MEDICARE: SHAILAH HICKS PTA
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
1225200000XPhysical Therapy Assistant2159876TX

General Provider Information

NPI Number : 1871178988
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAILAH HICKS PTA
Provider Business Mailing Address
First Line : 4709 RINCON WAY
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-5673
Country : US
Telephone Number : 817-683-5824
Fax Number :
Provider Business Practice Location Address
First Line : 2112 FORUM PKWY
Second Line :
City : BEDFORD
State : TX
Zip : 76021-6028
Country : US
Telephone Number : 817-799-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2021
Last Update Date : 03/10/2021

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Directions to “ SHAILAH HICKS PTA” Practice Location

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