Individual
STACEY MARCHUS HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7321 BALMER ST, BLDG. 570, HILL AFB, UT 84056-5012
(801) 777-5400
Mailing address
7321 BALMER ST, BLDG. 570, HILL AFB, UT 84056-5012
(801) 777-5400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT14617
CA
Other
Enumeration date
01/28/2011
Last updated
01/28/2011
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