Provider Demographics
NPI:1740775105
Name:MATRISCIANO, LOUIS JOHN III (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:JOHN
Last Name:MATRISCIANO
Suffix:III
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3463
Mailing Address - Country:US
Mailing Address - Phone:260-615-1218
Mailing Address - Fax:
Practice Address - Street 1:922 N CAPITOL AVE STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1005
Practice Address - Country:US
Practice Address - Phone:765-506-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer