| Doctor Name: | MR. TIMOTHY R. ICKES |
| NPI Number: | 1588854954 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | PT001895 |
| Business Practice Address: | 1509 W Main St Ste 201 Milton, WV - 255411105 |
| Business Phone Number: | 3047436995 |
| Business Fax Number: | 3047435778 |
| Mailing Address: | Po Box 687, GREENUP |
| State: | KY |
| Postal Code: | 411440687 |
| Phone Number: | 6064731080 |
| Fax Number: | 6064735875 |
| NPI Enumeration Date: | 07/31/2007 |
| NPI Last Update Date: | 07/31/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT001895 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |