Provider Demographics
NPI:1427064500
Name:BEHRMANN, DEAN RAYMOND (LAT/ATC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:RAYMOND
Last Name:BEHRMANN
Suffix:
Gender:M
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 WESTMORE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2557
Mailing Address - Country:US
Mailing Address - Phone:317-271-6653
Mailing Address - Fax:
Practice Address - Street 1:401 W MERIDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4215
Practice Address - Country:US
Practice Address - Phone:317-789-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000213A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2255A2300XOtherATHLETIC TRAINER