MEDICARE: ANDREA NICOLE LACKIDES DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	LPT-32567	AZ
2	225100000X	Physical Therapist	CP038756T	CO

General Provider Information

NPI Number	:	1144003039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NICOLE LACKIDES DPT

Provider Business Mailing Address
First Line	:	390 S WILCOX ST STE B
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1951
Country	:	US
Telephone Number	:	303-839-8068
Fax Number	:	303-835-3597

Provider Business Practice Location Address
First Line	:	390 S WILCOX ST STE B
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1951
Country	:	US
Telephone Number	:	303-839-8068
Fax Number	:	303-835-3597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	12/26/2025

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