Provider Demographics
NPI:1356638696
Name:SPICKA, MICHAEL J (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SPICKA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-0427
Mailing Address - Country:US
Mailing Address - Phone:402-443-4555
Mailing Address - Fax:402-443-4554
Practice Address - Street 1:559 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1280
Practice Address - Country:US
Practice Address - Phone:402-443-4555
Practice Address - Fax:402-443-4554
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist