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124 Monroe Street, Beaver Dam, WI 53916-2437 | |
(920) 885-6801 | |
(920) 885-6810 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 124 Monroe Street, Beaver Dam, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134181894 | NPI | - | NPPES |
40424500 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Thomas W Hyke |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1295797967 PECOS PAC ID: 1355305061 Enrollment ID: I20041116000492 |
Mailing Address | Practice Location Address |
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124 Monroe Street, Beaver Dam, WI 53916-2437 Ph: (920) 885-6801 | 124 Monroe Street, Beaver Dam, WI 53916-2437 Ph: (920) 885-6801 |