Provider Demographics
NPI:1427204312
Name:GERSTBAUER, CAMILLE (PTA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:GERSTBAUER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2691
Mailing Address - Country:US
Mailing Address - Phone:317-849-3517
Mailing Address - Fax:317-849-6397
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2691
Practice Address - Country:US
Practice Address - Phone:317-849-3517
Practice Address - Fax:317-849-6397
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003634A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant