Provider Demographics
NPI:1841738705
Name:LACKMEYER, DAMARA (MPT, CLT-LANA, CCI)
Entity Type:Individual
Prefix:
First Name:DAMARA
Middle Name:
Last Name:LACKMEYER
Suffix:
Gender:F
Credentials:MPT, CLT-LANA, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CROSSING DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41076
Mailing Address - Country:US
Mailing Address - Phone:859-572-2360
Mailing Address - Fax:859-441-1371
Practice Address - Street 1:106 CROSSING DRIVE
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:859-572-2360
Practice Address - Fax:859-441-1371
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist