Healthcare Provider Details

I. General information

NPI: 1902135270
Provider Name (Legal Business Name): THEA JANA QUIBOD RODRIGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEA JANA LIM QUIBOD

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 W 71ST ST STE 102
INDIANAPOLIS IN
46278-1785
US

IV. Provider business mailing address

5980 W 71ST ST STE 102
INDIANAPOLIS IN
46278
US

V. Phone/Fax

Practice location:
  • Phone: 317-388-0800
  • Fax: 317-388-0805
Mailing address:
  • Phone: 317-388-0800
  • Fax: 317-388-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: