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General NPI Number Information
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NPI Number | 1841738705
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Entity Type | Individual
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Provider Name | DAMARA LACKMEYER MPT, CLT-LANA, CCI
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Gender | Female
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 106 CROSSING DRIVE
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City | WILDER
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State | KY
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Zip | 41076
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Country | US
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Telephone | 859-572-2360
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Fax | 859-441-1371
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Provider Business Mailing Address
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Address Line | 106 CROSSING DRIVE
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City | WILDER
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State | KY
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Zip | 41076
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Country | US
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Telephone | 859-572-2360
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Fax | 859-441-1371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 003986
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License Number State | KY
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