Healthcare Provider Details

I. General information

NPI: 1386149003
Provider Name (Legal Business Name): ANDREW CRADLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 ARBORWOODS DR
BROWNSBURG IN
46112-7740
US

IV. Provider business mailing address

1530 ARBORWOODS DR
BROWNSBURG IN
46112-7740
US

V. Phone/Fax

Practice location:
  • Phone: 317-964-9132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: