Provider Demographics
NPI:1992194682
Name:HARDCASTLE, MICKEY ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICKEY
Middle Name:ANN
Last Name:HARDCASTLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 FEATHER TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7611
Mailing Address - Country:US
Mailing Address - Phone:251-990-3950
Mailing Address - Fax:
Practice Address - Street 1:1701 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2246
Practice Address - Country:US
Practice Address - Phone:251-943-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA6619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant