Provider Demographics
NPI:1447419916
Name:FIELDS, JEREMY R (PT, DPT, ATC/L)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PT, DPT, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 ILLINOIS ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8972
Mailing Address - Country:US
Mailing Address - Phone:317-817-1200
Mailing Address - Fax:317-817-1220
Practice Address - Street 1:10767 ILLINOIS ST STE 3000
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8972
Practice Address - Country:US
Practice Address - Phone:317-817-1200
Practice Address - Fax:317-817-1220
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1620225200000X
CT0004132255A2300X
IN05015824A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT120602553OtherNATABOC