Provider Demographics
NPI:1336417294
Name:HICKMAN, TALIA ELYSE (CPTA)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:ELYSE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 RAINBOW BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2918
Mailing Address - Country:US
Mailing Address - Phone:913-901-8462
Mailing Address - Fax:
Practice Address - Street 1:3910 RAINBOW BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2918
Practice Address - Country:US
Practice Address - Phone:913-901-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant