Elise L Hickernell, PT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT016068 Issued in OH

Practice address

8701 Troy Pike Ste 220
Huber Heights, OH 45424-1188

Phone

(937) 558-3338

Fax

(937) 558-3327

NPI assigned

Aug 25, 2005

Last updated

Jul 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anderson Physical Therapy Etc PC

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  • NPI 1346956554
  NPD (past)
• Excel Physical Therapy

  • Physical Therapist
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  • NPI 1760773501
  NPD (past)
• Mrs Physical Therapy

  • Physical Therapist
  • Erie, PA
  • NPI 1306893763
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1154314003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 TROY PIKE STE 220",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454241188",
            "telephone_number": "937-558-3338",
            "fax_number": "937-558-3327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 TROY PIKE STE 220",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454241188",
            "telephone_number": "937-558-3338",
            "fax_number": "937-558-3327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKERNELL",
        "first_name": "ELISE",
        "middle_name": "L",
        "credential": "PT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-25",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT017542",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT002641",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT016068",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT003841",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0007",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0005",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1746213",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101663154 0006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00245501",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "265998",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Lee Henry Sr., CPRS
• Nathan Andrew Herbert, LPN
• Amanda Rose Heredia, BSW, LSW
• Bridgette D Herren, LISW, LICDC, MSW
• Lauren Hess, PT, DPT
• Judith Hicks, OTR
• Brittany D High
• Timothy M Hilty, MD
• Hollins Counseling Services Inc
• Cory Holman

• Physical Therapist in Huber Heights, OH
• Providers in Huber Heights, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.