Individual
MR. TIMOTHY R. ICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1509 W MAIN ST STE 201, MILTON, WV 25541-1105
(304) 743-6995
(304) 743-5778
Mailing address
PO BOX 687, GREENUP, KY 41144-0687
(606) 473-1080
(606) 473-5875
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT001895
WV
Other
Enumeration date
07/31/2007
Last updated
07/31/2007
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