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NPI Code Detail

MEDICARE: SHINE PEDIATRIC THERAPY, LLC

MEDICARE: SHINE PEDIATRIC THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist
4103K00000XBehavior Analyst

General Provider Information

NPI Number : 1659017507
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHINE PEDIATRIC THERAPY, LLC
Provider Business Mailing Address
First Line : 8702 FOUNDERS RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8702 FOUNDERS RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1337
Country : US
Telephone Number : 317-452-9430
Fax Number :
Authorized Official
Title or Position : OWNER
Name : COURTNEY HODGE
Credential :
Telephone Number : 317-452-9430
Provider Enumeration Date : 05/12/2022
Last Update Date : 08/12/2024

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Directions to “SHINE PEDIATRIC THERAPY, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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