Provider Demographics
NPI:1518593870
Name:FOOTE, ROBERT TREVOR (CMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TREVOR
Last Name:FOOTE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4606
Mailing Address - Country:US
Mailing Address - Phone:317-345-8160
Mailing Address - Fax:
Practice Address - Street 1:212 W 10TH ST # SRB215
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5401
Practice Address - Country:US
Practice Address - Phone:317-345-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21505402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist