Individual
KOURTNEY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5505 129TH PL, APT 101, CRESTWOOD, IL 60445-1241
(773) 412-0503
Mailing address
5505 129TH PL, APT 101, CRESTWOOD, IL 60445-1241
(773) 412-0503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1600006340
IL
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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