Healthcare Provider Details

I. General information

NPI: 1699760694
Provider Name (Legal Business Name): PAUL E. PLUMMER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 NAAB RD SUITE 110
INDIANAPOLIS IN
46260-1972
US

IV. Provider business mailing address

253 COATSVILLE DR
WESTFIELD IN
46074-8496
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7746
  • Fax:
Mailing address:
  • Phone: 812-208-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000951A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: