Healthcare Provider Details

I. General information

NPI: 1942951710
Provider Name (Legal Business Name): MATTHEW REDMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 49TH ST
INDIANAPOLIS IN
46208-3480
US

IV. Provider business mailing address

6564 SIEBERT TRL
NINEVEH IN
46164-9453
US

V. Phone/Fax

Practice location:
  • Phone: 317-509-2196
  • Fax:
Mailing address:
  • Phone: 317-509-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36003730A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: