Provider Demographics
NPI:1790215416
Name:HICKOX, ASHLEY (DPT, PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HICKOX
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4316
Mailing Address - Country:US
Mailing Address - Phone:307-757-7232
Mailing Address - Fax:
Practice Address - Street 1:851 WERNER CT
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1305
Practice Address - Country:US
Practice Address - Phone:307-234-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist