Provider Demographics
NPI:1255409975
Name:HICKS, DEANA L (PT)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:L
Last Name:HICKS
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 1:5531 VIRGINIA PKWY.
Mailing Address - Street 2:STE. 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7824
Mailing Address - Country:US
Mailing Address - Phone:972-529-9292
Mailing Address - Fax:972-529-9293
Practice Address - Street 1:5305 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7824
Practice Address - Country:US
Practice Address - Phone:972-529-9292
Practice Address - Fax:972-529-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6869OtherBCBS
TX8J3703Medicare PIN