Provider Demographics
NPI:1639828221
Name:BASSLER, MACY (PT, DPT, CBS)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:BASSLER
Suffix:
Gender:F
Credentials:PT, DPT, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 RIGSBEES RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-8832
Mailing Address - Country:US
Mailing Address - Phone:606-315-3003
Mailing Address - Fax:
Practice Address - Street 1:128 RIGSBEES RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-8832
Practice Address - Country:US
Practice Address - Phone:606-315-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004318225100000X
174N00000X
KY0087502251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN