MEDICARE: HOLLI PICKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	002253	KY

General Provider Information

NPI Number	:	1700451283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLI PICKETT

Provider Business Mailing Address
First Line	:	1905 W HEBRON LN STE 106
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-7466
Country	:	US
Telephone Number	:	502-955-7705
Fax Number	:	502-957-1257

Provider Business Practice Location Address
First Line	:	1905 W HEBRON LN STE 106
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-7466
Country	:	US
Telephone Number	:	502-955-7705
Fax Number	:	502-957-1257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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Directions to “ HOLLI PICKETT ” Practice Location

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