Healthcare Provider Details

I. General information

NPI: 1558245258
Provider Name (Legal Business Name): PATRICK WAYNE MCNICKLE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

IV. Provider business mailing address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax: 303-694-9666
Mailing address:
  • Phone: 303-694-3333
  • Fax: 303-694-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021474
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025033895
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: