Provider Demographics
NPI:1346384823
Name:HILTON, MICAH LEA (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:LEA
Last Name:HILTON
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:LEA
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3727 GENE FIELD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1806
Practice Address - Country:US
Practice Address - Phone:816-396-8635
Practice Address - Fax:816-364-3522
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04726225100000X
MO2006034641225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8923OtherPHYSICLA THERAPY LICENSE
MO2006034641OtherPHYSICAL THERAPIST LICENSE