Provider Demographics
NPI:1659511012
Name:GAMBLIN, STEPHEN C (BCSI, LMT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:GAMBLIN
Suffix:
Gender:M
Credentials:BCSI, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 S MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6814
Mailing Address - Country:US
Mailing Address - Phone:812-330-0789
Mailing Address - Fax:
Practice Address - Street 1:2112 S MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6814
Practice Address - Country:US
Practice Address - Phone:812-330-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2025-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 172M00000X
INMT20902052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INMT20902052OtherINDIANA