Provider Demographics
NPI:1003037482
Name:RODEN-HICKS, KRISTEN ANN (PTA, LATC,)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:RODEN-HICKS
Suffix:
Gender:F
Credentials:PTA, LATC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6355
Mailing Address - Country:US
Mailing Address - Phone:410-997-1063
Mailing Address - Fax:
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:125
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6314
Practice Address - Country:US
Practice Address - Phone:410-997-1063
Practice Address - Fax:410-997-1408
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant