Organization
SHINE PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY HODGE (OWNER)
(317) 452-9430
Entity
Organization
Contact information
Practice address
8702 FOUNDERS RD, INDIANAPOLIS, IN 46268-1337
(317) 452-9430
Mailing address
8702 FOUNDERS RD, INDIANAPOLIS, IN 46268-1337
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
05/12/2022
Last updated
08/12/2024
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