Healthcare Provider Details

I. General information

NPI: 1548272743
Provider Name (Legal Business Name): MICHELLE M SPICKA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 N 26TH ST SUITE 100
LINCOLN NE
68521-4739
US

IV. Provider business mailing address

4231 BINGHAM LN
LINCOLN NE
68516-2947
US

V. Phone/Fax

Practice location:
  • Phone: 402-477-3110
  • Fax: 402-477-4990
Mailing address:
  • Phone: 402-429-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: