Organization
HICKOK REHABILITATION SERVICES, LLC
Active
Other names
Dunamis Therapy & Fitness
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY A HICKOK PT (OWNER/ PHYSICAL THERAPIST)
(715) 286-2203
Entity
Organization
Contact information
Practice address
836 RICHARD DR, SUITE B, EAU CLAIRE, WI 54701-6242
(715) 834-5850
Mailing address
P.O. BOX 418, AUGUSTA, WI 54722
(715) 286-2203
(715) 286-2076
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
4639-02
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000081145
MEDICARE PTAN FOR THORP & CHETEK
WI
05
—
40253000
—
WI
01
—
5336890002
DME PROVIDER #
WI
01
—
533689001
DME MEDICARE
WI
01
—
601601600
US DEPT OF LABOR
WI
01
—
68848
SECURITY HEALTH PLAN
WI
01
—
7397
GROUP HEALTH
WI
01
—
7398
GROUP HEALTH
WI
Enumeration date
06/11/2006
Last updated
08/24/2016
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