Provider Demographics
NPI:1538316633
Name:PANIAMOGAN, GLADYS O (RPT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:O
Last Name:PANIAMOGAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:MONDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N BOEKE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-5925
Mailing Address - Country:US
Mailing Address - Phone:812-477-1908
Mailing Address - Fax:
Practice Address - Street 1:601 N BOEKE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5925
Practice Address - Country:US
Practice Address - Phone:812-477-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007708A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist