Healthcare Provider Details

I. General information

NPI: 1134108061
Provider Name (Legal Business Name): DANIEL MATHERS MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 W CARMEL DR BLDG C
CARMEL IN
46032-8708
US

IV. Provider business mailing address

1185 W CARMEL DR BLDG C
CARMEL IN
46032-8708
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-6980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number05007274A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: