Provider Demographics
NPI:1538316492
Name:HICKLIN, ANDREA L (MS,PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:HICKLIN
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 CONCORD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2504
Mailing Address - Country:US
Mailing Address - Phone:301-946-7717
Mailing Address - Fax:301-946-8794
Practice Address - Street 1:10605 CONCORD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2504
Practice Address - Country:US
Practice Address - Phone:301-946-7717
Practice Address - Fax:301-946-8794
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist