Provider Demographics
NPI:1053125443
Name:HICKEY, MAURA EILEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:EILEEN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 POPLAR AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7503
Mailing Address - Country:US
Mailing Address - Phone:901-728-6912
Mailing Address - Fax:901-701-2428
Practice Address - Street 1:4515 POPLAR AVE STE 10
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7503
Practice Address - Country:US
Practice Address - Phone:901-728-6912
Practice Address - Fax:901-701-2428
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16782225100000X
PAPT033025225100000X
MD30303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist