Healthcare Provider Details

I. General information

NPI: 1477541209
Provider Name (Legal Business Name): RICHARD A SANTERRE LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 COLD SPRING RD
INDIANAPOLIS IN
46222-1960
US

IV. Provider business mailing address

16 TYLER CT
BROWNSBURG IN
46112-2034
US

V. Phone/Fax

Practice location:
  • Phone: 317-955-6122
  • Fax: 317-955-6121
Mailing address:
  • Phone: 317-852-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: