LARRY A HICKOK, PT — NPI 1245304971 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1245304971

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

831 DALLAS ST, CHETEK, WI, 54728-5811

✓ 9-Digit EDI 837 ZIP+4 (54728-5811)

Practice Phone & Referral Fax

(800) 974-4378

Fax: (630) 515-1536

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1245304971 (LARRY A HICKOK, PT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1245304971` (NPI-1 Individual Practitioner)
Provider / Legal Name	LARRY A HICKOK, PT
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	831 DALLAS ST, CHETEK, WI, 54728-5811
Practice Telephone / Fax	Tel: (800) 974-4378 \| Fax: (630) 515-1536
Administrative Mailing Address	24014 W RENWICK RD UNIT 206, PLAINFIELD, IL, 60544-8711
Enumeration & Last Sync	Enumerated: 2006-11-17 \| CMS Record Updated: 2024-05-08

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

831 DALLAS ST, CHETEK, WI, 54728-5811

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (LARRY A HICKOK, PT)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: WI \| License: `4639-24` \| Primary: Yes (Primary)
`2251X0800X` — Physical Therapist, Orthopedic Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist, Orthopedic	State: WI \| License: `4639-02` \| Primary: Secondary

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LARRY A HICKOK, PT (NPI #1245304971)