Individual
MATTHEW DAVID RADENCIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1595 S CALUMET RD, CHESTERTON, IN 46304-2388
(844) 896-0235
(219) 898-4258
Mailing address
PO BOX 2385, PORTAGE, IN 46368-5885
(844) 896-0235
(219) 898-4258
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
99080085A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196020A
—
IN
Enumeration date
06/08/2017
Last updated
06/08/2017
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