Provider Demographics
NPI:1295026896
Name:WICKLIFF, MICHELLE M
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:WICKLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 KETTLE DRUM ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-6304
Mailing Address - Country:US
Mailing Address - Phone:719-572-6857
Mailing Address - Fax:
Practice Address - Street 1:8382 KETTLE DRUM ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-6304
Practice Address - Country:US
Practice Address - Phone:719-572-6857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant