Provider Demographics
NPI:1639392608
Name:ALLEN, ELNORA HICKS (MS, PT)
Entity type:Individual
Prefix:
First Name:ELNORA
Middle Name:HICKS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:ELNORA
Other - Middle Name:H
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,PT
Mailing Address - Street 1:6146 MERRIFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2613
Mailing Address - Country:US
Mailing Address - Phone:804-230-2999
Mailing Address - Fax:804-230-2999
Practice Address - Street 1:6146 MERRIFIELD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2613
Practice Address - Country:US
Practice Address - Phone:804-230-2999
Practice Address - Fax:804-230-2999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305000883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist