Provider Demographics
NPI:1669618252
Name:HICKLIN, JOSEPHINE SULLIVAN (DPT)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:SULLIVAN
Last Name:HICKLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:SULLIVAN
Other - Last Name:HICKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:134 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1178
Mailing Address - Country:US
Mailing Address - Phone:803-329-4685
Mailing Address - Fax:
Practice Address - Street 1:134 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1178
Practice Address - Country:US
Practice Address - Phone:803-329-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist