Provider Demographics
NPI:1457715872
Name:HACKETT, KATY SCARLETT (PT)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:SCARLETT
Last Name:HACKETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:SCARLETT
Other - Last Name:PAREDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-926-4331
Mailing Address - Fax:423-926-5767
Practice Address - Street 1:3 PROFESSIONAL PARK DR STE 10
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6529
Practice Address - Country:US
Practice Address - Phone:423-926-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10711225100000X
GAPT012416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I658056Medicare PIN