Individual
SHANNON MILLER HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
6041 GARNERS FERRY RD, SUITE B, COLUMBIA, SC 29209-1304
(803) 783-0684
(803) 783-1147
Mailing address
1519 TAYLOR ST, COLUMBIA, SC 29201-2918
(803) 779-8327
(803) 799-3603
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6742
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42-6542
MEDICARE FACILITY PROVIDER NUMBER
SC
01
—
6742
SC BOARD OF PHYSICAL THERAPY EXAMINERS
SC
Enumeration date
07/18/2012
Last updated
07/18/2012
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