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General NPI Number Information
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NPI Number | 1265525869
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Entity Type | Individual
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Provider Name | JILL RENEE QUIGLEY LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5565 BROOKVILLE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-7109
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Country | US
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Telephone | 317-322-2985
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Fax | 317-322-2986
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Provider Business Mailing Address
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Address Line | 8152 WHITHAM DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8577
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Country | US
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Telephone | 317-538-1145
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Fax | 317-322-2986
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36001002A
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License Number State | IN
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