Healthcare Provider Details

I. General information

NPI: 1841105160
Provider Name (Legal Business Name): NOAH BRADYN WEST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MARKET ST
INDIANAPOLIS IN
46204-3001
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 317-423-0222
  • Fax:
Mailing address:
  • Phone: 803-812-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016491A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: