Provider Demographics
NPI:1295797967
Name:HYKE, THOMAS W (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:HYKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2437
Mailing Address - Country:US
Mailing Address - Phone:920-885-6801
Mailing Address - Fax:920-885-6810
Practice Address - Street 1:124 MONROE STREET
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2437
Practice Address - Country:US
Practice Address - Phone:920-885-6801
Practice Address - Fax:920-885-6810
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5558-024225100000X
WI5558-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40441200Medicaid
WI40441200Medicaid
WI000280275Medicare ID - Type Unspecified