Individual
ELLEN MYREE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5939 FLANK CIR, PORT REPUBLIC, VA 24471-2231
(540) 828-5368
(540) 515-3763
Mailing address
5939 FLANK CIR, PORT REPUBLIC, VA 24471-2231
(540) 828-5368
(540) 515-3763
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000363
VA
Other
Enumeration date
04/23/2015
Last updated
04/23/2015
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