Amanda Elaine Tackett, PTA
Individual provider Active NPI Physical Therapy Assistant · Thelma, KY
NPI 1124251582 · NPPES record last updated Sep 1, 2009
Key facts
- NPI
- 1124251582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A02313 (KY)
- Practice address
- 5659 Main Street
Thelma, KY 41260 - Phone
- (606) 788-6600
- Fax
- (606) 788-7076
- NPI assigned
- Sep 1, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A02313 | KY | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth of Kentucky | Past | Accepting new patients | |
| Commonwealth of Kentucky | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A02313 | KY | Yes |
Addresses
Primary practice location
5659 Main Street
Thelma, KY 41260
Mailing address
5659 Main St
Thelma, KY 41260-8609
Phone (606) 788-6600
Other providers in Thelma, KY
All providers in Thelma, KY · Physical Therapy Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.