Provider Demographics
NPI:1265525869
Name:QUIGLEY, JILL RENEE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 WHITHAM DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8577
Mailing Address - Country:US
Mailing Address - Phone:317-538-1145
Mailing Address - Fax:317-322-2986
Practice Address - Street 1:5565 BROOKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-7109
Practice Address - Country:US
Practice Address - Phone:317-322-2985
Practice Address - Fax:317-322-2986
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001002A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer