Healthcare Provider Details

I. General information

NPI: 1245777507
Provider Name (Legal Business Name): KADEN SLOAN LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN ST
DANVILLE IN
46122-1706
US

IV. Provider business mailing address

2644 APPLECARD DR
INDIANAPOLIS IN
46234-8828
US

V. Phone/Fax

Practice location:
  • Phone: 812-243-3394
  • Fax:
Mailing address:
  • Phone: 812-243-3394
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05014369A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002782A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: