Provider Demographics
NPI:1841542578
Name:HICKMAN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:HICKMAN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-792-2223
Mailing Address - Street 1:18780 S 68TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68372-7083
Mailing Address - Country:US
Mailing Address - Phone:402-792-2223
Mailing Address - Fax:402-792-2228
Practice Address - Street 1:18780 S 68TH ST STE A
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:NE
Practice Address - Zip Code:68372-7083
Practice Address - Country:US
Practice Address - Phone:402-792-2223
Practice Address - Fax:402-792-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty