Provider Demographics
NPI:1174591697
Name:HICKES, JUDITH H (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:H
Last Name:HICKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2405
Mailing Address - Country:US
Mailing Address - Phone:252-447-4005
Mailing Address - Fax:252-447-4001
Practice Address - Street 1:1202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2405
Practice Address - Country:US
Practice Address - Phone:252-447-4005
Practice Address - Fax:252-447-4001
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003427L225100000X
NC13487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist