Basic Information
| Provider Information | |||||||||
| NPI: | 1003037482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODEN-HICKS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PTA, LATC, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 CLIPPER PARK RD | ||||||||
| Address2: | UNIT 125 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212111460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109615242 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9501 OLD ANNAPOLIS RD | ||||||||
| Address2: | 125 | ||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210426314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109971063 | ||||||||
| FaxNumber: | 4109971408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A2402 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.