Healthcare Provider Details

I. General information

NPI: 1245577832
Provider Name (Legal Business Name): STEVEN PORTERFIELD LAT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8227 NORTHWEST BLVD SUITE160
INDIANAPOLIS IN
46278-1387
US

IV. Provider business mailing address

12592 BLUE HOLLY DR APT 33
NOBLESVILLE IN
46060-4553
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5747
  • Fax:
Mailing address:
  • Phone: 317-590-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001961A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: