Organization
IMPACT ATHLETICS INCORPORATED
Active
Other names
Impact Athletics
Organization subpart
No
Provider details
NPI number
Authorized official
JACK HAM (PRESIDENT)
(669) 666-4936
Entity
Organization
Contact information
Practice address
9525 N MERIDIAN ST, INDIANAPOLIS, IN 46260-1310
(317) 669-2375
Mailing address
9525 N MERIDIAN ST, INDIANAPOLIS, IN 46260-1310
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
—
—
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
06/03/2024
Last updated
07/13/2024
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