Provider Demographics
NPI:1063719086
Name:HICKS, HELEN MARIE BUNNY (PTA)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:MARIE BUNNY
Last Name:HICKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-5315
Mailing Address - Country:US
Mailing Address - Phone:423-802-1433
Mailing Address - Fax:
Practice Address - Street 1:224 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-5315
Practice Address - Country:US
Practice Address - Phone:423-802-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000003361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant