Organization
PEDIATRIC PHYSICAL THERAPY, LLC
Active
Organization
PEDIATRIC PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY E HICKMAN PT (PRESIDENT)
(304) 366-8395
Entity
Organization
Contact information
Practice address
RR 6 BOX 260-6E, FAIRMONT, WV 26554-9396
(304) 367-0750
Mailing address
PO BOX 88, COLFAX, WV 26566-0088
(304) 367-0750
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
1046-0165
WV
261QP2000X
Physical Therapy Clinic/Center
Primary
1046-0165
WV
Other
Enumeration date
03/25/2012
Last updated
03/25/2012
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