Healthcare Provider Details

I. General information

NPI: 1124224407
Provider Name (Legal Business Name): CARL OWEN EATON P.T, A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S PENNSYLVANIA ST
INDIANAPOLIS IN
46204-3610
US

IV. Provider business mailing address

2221 COLFAX LN
INDIANAPOLIS IN
46260-6601
US

V. Phone/Fax

Practice location:
  • Phone: 317-917-2942
  • Fax:
Mailing address:
  • Phone: 317-697-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number05008689A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: