Provider Demographics
NPI:1134163603
Name:CIBULKA, MICHAEL THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:CIBULKA
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 1:1330 YMCA DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2661
Mailing Address - Country:US
Mailing Address - Phone:636-931-7600
Mailing Address - Fax:636-931-8808
Practice Address - Street 1:1330 YMCA DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2661
Practice Address - Country:US
Practice Address - Phone:636-931-7600
Practice Address - Fax:636-931-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001014632Medicare PIN
MO000025041Medicare PIN