Individual
MS. ELIZABETH FACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4610 CHAMBERLAIN LN, LOUISVILLE, KY 40241-1160
(502) 618-8200
(502) 618-8201
Mailing address
PO BOX 306393, NASHVILLE, TN 37230-6393
(615) 373-1350
(615) 221-9054
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4925
KY
2251X0800X
Orthopedic Physical Therapist
004925
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484220
ANTHEM PROVIDER ID
KY
01
—
KY4925
KY STATE LICENSE
KY
Enumeration date
02/16/2007
Last updated
07/30/2020
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