Provider Demographics
NPI:1275682759
Name:FLICKER, MICHAEL THOMAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:FLICKER
Suffix:
Gender:M
Credentials:ATC
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 3072
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3072
Mailing Address - Country:US
Mailing Address - Phone:828-328-7054
Mailing Address - Fax:
Practice Address - Street 1:STASAVICH PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28603-3072
Practice Address - Country:US
Practice Address - Phone:828-328-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer