Organization
PROTEAM TACTICAL PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEY VANDEVER (CEO)
(317) 892-8180
Entity
Organization
Contact information
Practice address
8025 COMBS RD, INDIANAPOLIS, IN 46237-9588
(317) 804-3501
Mailing address
1531 E NORTHFIELD DR, BROWNSBURG, IN 46112-2513
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336112135
NPPES
IN
01
—
1366871915
NPPES
IN
01
—
1396391918
NPPES
IN
01
—
1407295181
NPPES
IN
01
—
1417421793
NPPES
IN
01
—
1639497795
NPPES
IN
01
—
1750854873
NPPES
IN
01
—
1871916783
NPPES
IN
01
—
1891789418
NPPES
IN
Enumeration date
11/21/2018
Last updated
12/15/2020
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