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1770197311
MIKEL THACKER
RUSSELLVILLE, AR
NPI
1770197311
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: AR 4868)
Enumeration Date
2020-09-01
Last Update Date
2020-09-01
Business Address
Dr. MIKEL THACKER PT
115 SKYLINE DR STE A
RUSSELLVILLE, AR 72802-3310
Phone number: 479-967-5155
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Mailing Address
Dr. MIKEL THACKER PT
3325 LOETSCHER CIR
CONWAY, AR 72034-3503
Phone number: 479-214-1234
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