Provider Demographics
NPI:1497438980
Name:MESSMER, SAMUEL EDWARD (ATC, LAT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDWARD
Last Name:MESSMER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 W MIDLAND MDWS
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5192
Mailing Address - Country:US
Mailing Address - Phone:812-798-9170
Mailing Address - Fax:
Practice Address - Street 1:326 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JASONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47438-1510
Practice Address - Country:US
Practice Address - Phone:812-798-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003472A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer