Provider Demographics
NPI:1578930541
Name:HICKEY, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-2012
Mailing Address - Country:US
Mailing Address - Phone:814-837-8272
Mailing Address - Fax:
Practice Address - Street 1:190 FRALEY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735
Practice Address - Country:US
Practice Address - Phone:814-837-8955
Practice Address - Fax:814-837-6592
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006384L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist