MEDICARE: MR. CARL OWEN EATON P.T, A.T.C.

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
1	2251S0007X	Sports Physical Therapist	05008689A	IN
2	2255A2300X	Athletic Trainer	36001221A	IN

General Provider Information

NPI Number	:	1124224407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL OWEN EATON P.T, A.T.C.

Provider Business Mailing Address
First Line	:	2221 COLFAX LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-6601
Country	:	US
Telephone Number	:	317-697-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S PENNSYLVANIA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3610
Country	:	US
Telephone Number	:	317-917-2942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	09/11/2025

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