Provider Demographics
NPI:1003467630
Name:LAUNSTEIN, ETHAN DANIEL (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:DANIEL
Last Name:LAUNSTEIN
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 1:584 E COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9647
Mailing Address - Country:US
Mailing Address - Phone:517-525-1679
Mailing Address - Fax:
Practice Address - Street 1:19000 GRAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-6803
Practice Address - Country:US
Practice Address - Phone:317-804-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program