Provider Demographics
NPI:1114228186
Name:HICKS, CINDY S (PTA)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:S
Last Name:HICKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10410 N. KENSINGTON PARKWAY
Mailing Address - Street 2:KENSINGTON PARKWAY
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2943
Mailing Address - Country:US
Mailing Address - Phone:301-929-3630
Mailing Address - Fax:301-929-3609
Practice Address - Street 1:10410 KENSINGTON PKWY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2943
Practice Address - Country:US
Practice Address - Phone:301-929-3630
Practice Address - Fax:301-929-3609
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA-2201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant