Healthcare Provider Details

I. General information

NPI: 1023725926
Provider Name (Legal Business Name): HALLE K STREGE LAT, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46250-2943
US

IV. Provider business mailing address

9881 S 575 W
FORTVILLE IN
46040-9221
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6024
  • Fax: 317-497-2507
Mailing address:
  • Phone: 317-263-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36003744A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006785
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: