Provider Demographics
NPI:1790189371
Name:HICKS, MEAGAN LYNELLE (DPT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LYNELLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CORBIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2903
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:200 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9416
Practice Address - Country:US
Practice Address - Phone:606-439-4777
Practice Address - Fax:606-439-4448
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist