| Doctor Name: | MR. TIMOTHY SCOTT ZICKUS |
| NPI Number: | 1609920818 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.P.T. |
| License Number: | 2003011115 |
| Business Practice Address: | 221 W Pointe Dr Suite 1 Swansea, IL - 622268306 |
| Business Phone Number: | 3146038299 |
| Business Fax Number: | |
| Mailing Address: | 3401 Macklind Ave, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631391540 |
| Phone Number: | 3143520615 |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2007 |
| NPI Last Update Date: | 05/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2003011115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |