Individual
JACOB ETHERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8142 GRASSY MEADOW LN, INDIANAPOLIS, IN 46259-7721
(317) 513-9282
Mailing address
8142 GRASSY MEADOW LN, INDIANAPOLIS, IN 46259-7721
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/31/2015
Last updated
01/31/2015
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