Provider Demographics
NPI:1366752990
Name:HICKS, JOSHUA GARRISON (LPTA)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:GARRISON
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 LAKE ROYALE
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-7449
Mailing Address - Country:US
Mailing Address - Phone:252-478-7819
Mailing Address - Fax:
Practice Address - Street 1:114 SMOKETREE WAY
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2117
Practice Address - Country:US
Practice Address - Phone:919-496-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant