Matthew David Radencic, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

99080085A Issued in IN

Practice address

1595 S Calumet Rd
Chesterton, IN 46304-2388

Phone

(844) 896-0235

Fax

(219) 898-4258

NPI assigned

Jun 8, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1043749567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2385",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685885",
            "telephone_number": "844-896-0235",
            "fax_number": "219-898-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 S CALUMET RD",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042388",
            "telephone_number": "844-896-0235",
            "fax_number": "219-898-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADENCIC",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "99080085A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200196020A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.