Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Mikel Thacker, PT

Individual provider Physical Therapist · NPI 1770197311

Dr. Mikel Thacker, PT is a Physical Therapist in Private Practice in Russellville, Arkansas. Qualified in 2020, 6 years ago. Practices with Coulter Physical Therapy, Inc, a 3-clinician group and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
6
Licensed in
AR
In the registry since
2020
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

115 Skyline Dr Ste A
Russellville, AR 72802-3310
Phone: (479) 967-5155
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 4868 (AR)

Record details

NPI number1770197311
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorYes
NPI enumeratedSeptember 1, 2020
Last updated in NPPESSeptember 1, 2020
Certification dateSeptember 1, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Coulter Physical Therapy, Inc. — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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