Provider Demographics
NPI:1992484786
Name:HICKEY, ANNA-LYNN MCCLENNEY (DPT)
Entity type:Individual
Prefix:
First Name:ANNA-LYNN
Middle Name:MCCLENNEY
Last Name:HICKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14286 BEACH BLVD STE 34
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1570
Mailing Address - Country:US
Mailing Address - Phone:904-345-7510
Mailing Address - Fax:
Practice Address - Street 1:14286 BEACH BLVD STE 34
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1570
Practice Address - Country:US
Practice Address - Phone:904-345-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist