Provider Demographics
NPI:1992279954
Name:MATTERN, MARK THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:MATTERN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8601
Mailing Address - Country:US
Mailing Address - Phone:317-528-6646
Mailing Address - Fax:
Practice Address - Street 1:315 N DAN JONES RD STE 140
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2817
Practice Address - Country:US
Practice Address - Phone:317-837-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist