Provider Demographics
NPI:1366045759
Name:CABAGE, COLIN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:MICHAEL
Last Name:CABAGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9919 TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8260
Mailing Address - Country:US
Mailing Address - Phone:317-872-4166
Mailing Address - Fax:317-872-3234
Practice Address - Street 1:9919 TOWNE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8260
Practice Address - Country:US
Practice Address - Phone:317-872-4166
Practice Address - Fax:317-872-3234
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013863A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200383410AMedicaid