Healthcare Provider Details

I. General information

NPI: 1760424113
Provider Name (Legal Business Name): HICKOK REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 RICHARD DR SUITE B
EAU CLAIRE WI
54701-6242
US

IV. Provider business mailing address

P.O. BOX 418
AUGUSTA WI
54722
US

V. Phone/Fax

Practice location:
  • Phone: 715-834-5850
  • Fax:
Mailing address:
  • Phone: 715-286-2203
  • Fax: 715-286-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4639-02
License Number StateWI

VIII. Authorized Official

Name: LARRY A HICKOK
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: PT
Phone: 715-286-2203