Provider Demographics
NPI:1366327116
Name:HICKMAN, RYAN MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2740
Mailing Address - Country:US
Mailing Address - Phone:306-713-8471
Mailing Address - Fax:
Practice Address - Street 1:336 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3126
Practice Address - Country:US
Practice Address - Phone:406-285-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-32685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist