Individual
BRYAN DOUGLAS HICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
837 E WINDSOR AVE, PHOENIX, AZ 85006-1044
(480) 745-0499
Mailing address
837 E WINDSOR AVE, PHOENIX, AZ 85006-1044
(480) 745-0499
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-15513
AZ
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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