MEDICARE: JON ANTHONY RAMOS ATC, PTA, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06001886A	IN
2	2255A2300X	Athletic Trainer	36000741A	IN

General Provider Information

NPI Number	:	1912961053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON ANTHONY RAMOS ATC, PTA, LAT

Provider Business Mailing Address
First Line	:	201 PENNSYLVANIA PKWY STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-1393
Country	:	US
Telephone Number	:	317-817-1200
Fax Number	:	317-817-1220

Provider Business Practice Location Address
First Line	:	201 PENNSYLVANIA PKWY STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-1393
Country	:	US
Telephone Number	:	317-817-1200
Fax Number	:	317-817-1220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/17/2018

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