Provider Demographics
NPI:1861650038
Name:HICKS, THANH LIEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:LIEN
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 1:1205 CORNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71851-8968
Mailing Address - Country:US
Mailing Address - Phone:703-659-9073
Mailing Address - Fax:
Practice Address - Street 1:4610 CHAMBERLAIN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1160
Practice Address - Country:US
Practice Address - Phone:502-618-8200
Practice Address - Fax:502-618-8201
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203319225100000X
KY007309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist