Provider Demographics
NPI:1457372617
Name:HICKLING, DANIEL E (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HICKLING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 SOUTH MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-951-4511
Mailing Address - Fax:540-552-4050
Practice Address - Street 1:3706 SOUTH MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-951-4511
Practice Address - Fax:540-552-4050
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050031762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
250995OtherALLIANCE
242722301OtherUNITED HEALTHCARE
VA322831OtherANTHEM
289241OtherSOUTHERN HBACTH
250995OtherALLIANCE