MR. Ellis Ray Tackett III, ATC LAT

NPI #1821489576 in Pikeville, Kentucky

Provider Information

NPI Number: 1821489576
Entity Type: Individual
Name: MR. Ellis Ray Tackett III, ATC LAT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: ATC LAT
Enumeration Date: Feb 16, 2015
Last Updated: Feb 16, 2015

Practice Location

Address: 147 SYCAMORE ST
City: Pikeville
State: Kentucky
ZIP Code: 41501-9118
Phone: (606) 213-1620

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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