Provider Demographics
NPI:1164954954
Name:HICKMAN, COLTON (DO)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:817-702-1173
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST STREET ERMIRE
Practice Address - Street 2:SUITE 11516
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:817-702-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12229946-1204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation