Provider Demographics
NPI:1437252756
Name:DECKARD, KAREN YEVETT (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:YEVETT
Last Name:DECKARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0015
Mailing Address - Country:US
Mailing Address - Phone:270-251-3590
Mailing Address - Fax:270-251-3586
Practice Address - Street 1:417 S 6TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2328
Practice Address - Country:US
Practice Address - Phone:270-251-3590
Practice Address - Fax:270-251-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700058400Medicaid
KY000000067871OtherANTHEM BCBS
KY000000067871OtherANTHEM BCBS
8882Medicare ID - Type UnspecifiedGROUP
S72347Medicare UPIN