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Individual

MALCOLM JAMES LICKERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
8191 STAPLES MILL RD, HENRICO, VA 23228-2751
(804) 523-2653
Mailing address
3307 QUAIL HILL DR, MIDLOTHIAN, VA 23112-4431

Taxonomy

Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
2305202376
VA

Other

Enumeration date
10/05/2020
Last updated
10/05/2020
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