Provider Demographics
NPI:1992867485
Name:HICKEY, EDWARD RYAN (PTX)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:RYAN
Last Name:HICKEY
Suffix:
Gender:M
Credentials:PTX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MILL ST APT 102
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-8200
Mailing Address - Country:US
Mailing Address - Phone:401-597-0599
Mailing Address - Fax:
Practice Address - Street 1:353 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4936
Practice Address - Country:US
Practice Address - Phone:401-751-6900
Practice Address - Fax:401-751-6902
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT018512251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics