Tackett Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

TACKETT PHYSICAL THERAPY PLLC

Practice address

102 W Madison St
La Grange, KY 40031-1428

Phone

(606) 207-5248

NPI assigned

Mar 11, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trent Tackett, PT, DPTNPI 1689288219

Title

Owner/Physical Therapist

Phone

(606) 207-5248

Specialties & licenses 1

Addresses

Other names 1

• ReActivate Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trent Morgan Tackett, DPT

  • Physical Therapist
  • Louisville, KY
  • NPI 1689288219

  KY, Physical Therapist

  Medicare reassignment NPD Authorized official
• Laurence Daniel Preble, D.C.

  • Chiropractor
  • Lagrange, KY
  • NPI 1023103181
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1003674409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W MADISON ST",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400311428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W MADISON ST",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400311428",
            "telephone_number": "606-207-5248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKETT PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-10",
        "status": "A",
        "authorized_official_last_name": "TACKETT",
        "authorized_official_first_name": "TRENT",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "606-207-5248",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReActivate Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyler Stickle, M.ED., LPCC
• Jessica Marie Stith, MSN, APRN, FNP-BC
• Jessica Ruth Stumbo, M.D.
• Christy Sturgill, ARNP
• Kim Machtolff Swett, CCC-SLP
• Cheryl Tarhi
• Sarah Thayer, M.D.
• Rachel K Theiler, NTP
• Ann Seibert Thomas
• Debra Carole Thompson, M.ED., OTR/L

• All providers in La Grange, KY
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.