MEDICARE: DR. MARCUS LOGAN HINKLE DPT

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	2251X0800X	Orthopedic Physical Therapist	05011284A	IN
2	225100000X	Physical Therapist	PT009666	GA

General Provider Information

NPI Number	:	1922237361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS LOGAN HINKLE DPT

Provider Business Mailing Address
First Line	:	75 EXECUTIVE DR STE C
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2993
Country	:	US
Telephone Number	:	317-900-9691
Fax Number	:	317-912-1323

Provider Business Practice Location Address
First Line	:	14540 PRAIRIE LAKES BLVD N
Second Line	:	STE 103
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4366
Country	:	US
Telephone Number	:	770-778-3526
Fax Number	:	317-912-1323

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

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	01/19/2023

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