Provider Demographics
NPI:1437843182
Name:LYLES, MICHAELA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:NICOLE
Last Name:LYLES
Suffix:
Gender:F
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 1:7961 BARRAPORT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5669
Mailing Address - Country:US
Mailing Address - Phone:316-796-6763
Mailing Address - Fax:
Practice Address - Street 1:114 SUNBIRD CLIFFS LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-8013
Practice Address - Country:US
Practice Address - Phone:719-306-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist