| Tackett Physical Therapy Pllc | |
|
102 W Madison St, La Grange, KY 40031-1428 | |
| (606) 207-5248 | |
| Not Available |
| Full Name | Tackett Physical Therapy Pllc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 102 W Madison St, La Grange, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003674409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Provider Name | Trent Tackett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689288219 PECOS PAC ID: 2365855764 Enrollment ID: I20210104000243 |
| Mailing Address | Practice Location Address |
|---|---|
| Tackett Physical Therapy Pllc 102 W Madison St, La Grange, KY 40031-1428 Ph: () - | Tackett Physical Therapy Pllc 102 W Madison St, La Grange, KY 40031-1428 Ph: (606) 207-5248 |
Jordan Crandell, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1407 E Crystal Dr Ste E, La Grange, KY 40031 Phone: 502-222-0280 | |
Cassidy Nicole Raibert, PT, DPT, NCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4603 Timberwalk Ct, La Grange, KY 40031 Phone: 703-864-6695 | |
Dr. Levi Ray Bristow, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 2612 Sunningdale Pl W, La Grange, KY 40031 Phone: 502-759-2879 | |
Julie Nicole Sergent, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2801 Heather Green Blvd, La Grange, KY 40031 Phone: 502-802-0156 | |
Garret Scaman, Physical Therapist Medicare: Medicare Enrolled Practice Location: 1407 E Crystal Dr Ste E, La Grange, KY 40031 Phone: 502-222-0280 Fax: 502-222-0290 | |
Amro Moadi, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 4603 Timberwalk Ct, La Grange, KY 40031 Phone: 703-864-6695 Fax: 888-830-3233 |