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General NPI Number Information
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NPI Number | 1881803799
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Entity Type | Individual
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Provider Name | MATTHEW DAVID TRICKER PTA
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5506 E 16TH ST SUIT B10
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-4935
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Country | US
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Telephone | 317-355-5905
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Fax |
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Provider Business Mailing Address
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Address Line | 9913 ELLSWORTH LN
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City | AVON
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State | IN
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Zip | 46123-8643
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Country | US
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Telephone | 317-271-6638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06002641
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License Number State | IN
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