Provider Demographics
NPI:1689128332
Name:HEBENSTREIT, CASEY JAMES (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JAMES
Last Name:HEBENSTREIT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 PIPESTONE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-9202
Mailing Address - Country:US
Mailing Address - Phone:317-496-2630
Mailing Address - Fax:
Practice Address - Street 1:1400 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3630
Practice Address - Country:US
Practice Address - Phone:317-788-3309
Practice Address - Fax:317-788-3472
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer