Individual
DR. MIKEL THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
115 SKYLINE DR STE A, RUSSELLVILLE, AR 72802-3310
(479) 967-5155
Mailing address
3325 LOETSCHER CIR, CONWAY, AR 72034-3503
(479) 214-1234
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4868
AR
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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