Provider Demographics
NPI:1437304144
Name:CABALAN, VISSEA ARNOLD TRINIDAD (PT)
Entity Type:Individual
Prefix:
First Name:VISSEA ARNOLD
Middle Name:TRINIDAD
Last Name:CABALAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 LAKELAND TRAILS BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-8720
Mailing Address - Country:US
Mailing Address - Phone:317-431-3204
Mailing Address - Fax:
Practice Address - Street 1:7110 LAKELAND TRAILS BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-8720
Practice Address - Country:US
Practice Address - Phone:317-431-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003865A2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics