Provider Demographics
NPI:1922580521
Name:HILL, LAKISHA SHANAY (PTA)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:SHANAY
Last Name:HILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LAKISHA
Other - Middle Name:SHANAY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
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:423-362-8684
Practice Address - Street 1:1438 HIGHWAY 16 W STE C
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2096
Practice Address - Country:US
Practice Address - Phone:770-233-0350
Practice Address - Fax:770-233-0370
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant