Individual
MATTHEW WILLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1010 MEMORIAL WAY STE 100, FORT WAYNE, IN 46805-1368
(260) 341-9427
Mailing address
508 GLENFIELD DR, FORT WAYNE, IN 46825-4083
(260) 341-9427
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001778A
IN
Other
Enumeration date
08/27/2014
Last updated
03/17/2018
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