Individual provider · Type 1 NPI

Ellis Ray Tackett Iii, ATC LAT

Specialist · Pikeville, KY

NPI number 1821489576 Active

Practice location

147 Sycamore St
Pikeville, KY 41501-9118

Call (606) 213-1620 Map

Fax (606) 218-5353

Mailing address

680 Hambley Blvd Apt 407
Pikeville, KY 41501-3804

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XAT1092 (KY)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1821489576

Ellis Ray Tackett Iii, ATC LAT's National Provider Identifier is 1821489576, issued on Feb 16, 2015. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Pikeville, KY. The record was last updated on Feb 16, 2015.