Provider Demographics
NPI:1649244195
Name:SCHMIDT, IAN DANIEL (AT,C/L)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:DANIEL
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:AT,C/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PENNSYLVANIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2301
Mailing Address - Country:US
Mailing Address - Phone:317-208-1562
Mailing Address - Fax:317-817-1248
Practice Address - Street 1:201 PENNSYLVANIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2301
Practice Address - Country:US
Practice Address - Phone:317-208-1562
Practice Address - Fax:317-817-1248
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000799A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer