Stacey Marchus Hickman, PT
Individual provider Active NPI Physical Therapist · Hill Afb, UT
NPI 1578869244 · NPPES record last updated Jan 28, 2011
Key facts
- NPI
- 1578869244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT14617 (CA)
- Practice address
- 7321 Balmer St
BLDG. 570
Hill Afb, UT 84056-5012 - Phone
- (801) 777-5400
- NPI assigned
- Jan 28, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT14617 | CA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT14617 | CA | Yes |
Addresses
Primary practice location
7321 Balmer St
BLDG. 570
Hill Afb, UT 84056-5012
Mailing address
7321 Balmer St
BLDG. 570
Hill Afb, UT 84056-5012
Phone (801) 777-5400
Other providers in Hill Afb, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.