MEDICARE: MICHAELA NICOLE LYLES PT, 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

General Provider Information

NPI Number	:	1437843182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA NICOLE LYLES PT, DPT

Provider Business Mailing Address
First Line	:	7961 BARRAPORT DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5669
Country	:	US
Telephone Number	:	316-796-6763
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 SUNBIRD CLIFFS LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8013
Country	:	US
Telephone Number	:	719-306-0009
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	10/10/2024

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