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NPI Code Detail

MEDICARE: MATTHEW WARDELL LAT, ATC

MEDICARE: MATTHEW WARDELL LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
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General Provider Information

NPI Number : 1063342319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW WARDELL LAT, ATC
Provider Business Mailing Address
First Line : 923 N MERIDIAN ST APT 502
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46204-1448
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3630
Country : US
Telephone Number : 317-488-0743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “ MATTHEW WARDELL LAT, ATC” Practice Location

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