MEDICARE: JONATHAN TODD LEDET PTA

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1407426802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN TODD LEDET PTA

Provider Business Mailing Address
First Line	:	10224 NOBLE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-7717
Country	:	US
Telephone Number	:	260-243-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 E VERMONT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3690
Country	:	US
Telephone Number	:	317-997-0065
Fax Number	:

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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Directions to “ JONATHAN TODD LEDET PTA” Practice Location

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