Active NPI
Matthew David Tricker, PTA
- Physical Therapy Assistant
- Indianapolis, IN
National Provider Identifier
1881803799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06002641
- Practice address
- 5506 E 16TH St
Suit B10
Indianapolis, IN 46218-4935 - Phone
- (317) 355-5905
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06002641 | IN | Primary |
Addresses
Primary practice location
5506 E 16TH St
Suit B10
Indianapolis, IN 46218-4935
Mailing address
9913 Ellsworth LN
Avon, IN 46123-8643
Phone (317) 271-6638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06002641 | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881803799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9913 ELLSWORTH LN",
"city": "AVON",
"state": "IN",
"postal_code": "461238643",
"telephone_number": "317-271-6638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5506 E 16TH ST",
"address_2": "SUIT B10",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462184935",
"telephone_number": "317-355-5905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRICKER",
"first_name": "MATTHEW",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06002641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.