Provider Demographics
NPI:1235325127
Name:ARTEAGA, GLORIA NELSAN (PT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:NELSAN
Last Name:ARTEAGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 CHARLEVOIX WAY
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1292
Mailing Address - Country:US
Mailing Address - Phone:219-689-7507
Mailing Address - Fax:
Practice Address - Street 1:8840 CALUMET AVE STE 103
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-703-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22581225100000X
IN05005669A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist