Individual
LARRY A HICKOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
831 DALLAS ST, CHETEK, WI 54728-5811
(800) 974-4378
(630) 515-1536
Mailing address
24014 W RENWICK RD UNIT 206, PLAINFIELD, IL 60544-8711
(800) 974-4378
(630) 515-1536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4639-24
WI
2251X0800X
Orthopedic Physical Therapist
4639-02
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40253000
—
WI
Enumeration date
11/17/2006
Last updated
05/08/2024
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