Healthcare Provider Details

I. General information

NPI: 1598601437
Provider Name (Legal Business Name): SHELLY M HACKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 DECOURSEY AVE
COVINGTON KY
41015-1436
US

IV. Provider business mailing address

409 W 22ND ST # 2
COVINGTON KY
41014-1605
US

V. Phone/Fax

Practice location:
  • Phone: 859-413-2273
  • Fax:
Mailing address:
  • Phone: 859-777-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: