Individual
ELISE L HICKERNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, ATC
Contact information
Practice address
8701 TROY PIKE STE 220, HUBER HEIGHTS, OH 45424-1188
(937) 558-3338
(937) 558-3327
Mailing address
8701 TROY PIKE STE 220, HUBER HEIGHTS, OH 45424-1188
(937) 558-3338
(937) 558-3327
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
DAPT002641
PA
225100000X
Physical Therapist
Primary
PT016068
OH
225100000X
Physical Therapist
PT017542
PA
2255A2300X
Athletic Trainer
RT003841
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101663154 0001
—
PA
05
—
101663154 0002
—
PA
05
—
101663154 0003
—
PA
05
—
101663154 0004
—
PA
05
—
101663154 0005
—
PA
05
—
101663154 0006
—
PA
05
—
101663154 0007
—
PA
01
—
1746213
HIGHMARK
PA
01
—
265998
HEALTH AMERICA
PA
01
—
P00245501
RAILROAD
PA
Enumeration date
08/25/2005
Last updated
07/24/2023
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