Provider Demographics
NPI:1871723809
Name:HICKSON, DONNA JEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:HICKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:HONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT,CSCS,CKTP
Mailing Address - Street 1:1507 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4946
Mailing Address - Country:US
Mailing Address - Phone:410-747-3213
Mailing Address - Fax:
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-363-4887
Practice Address - Fax:410-363-3599
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist