Healthcare Provider Details

I. General information

NPI: 1841542578
Provider Name (Legal Business Name): HICKMAN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 S 68TH ST STE A
HICKMAN NE
68372-7083
US

IV. Provider business mailing address

18780 S 68TH ST STE A
HICKMAN NE
68372-7083
US

V. Phone/Fax

Practice location:
  • Phone: 402-792-2223
  • Fax: 402-792-2228
Mailing address:
  • Phone: 402-792-2223
  • Fax: 402-792-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CASEY J. MOELLER
Title or Position: OWNER / PT
Credential: PT
Phone: 402-792-2223