Most Relevant Information
Provider Data
| NPI Number: | 1003424722 |
| Provider Name: | CELEMAR VALDEVIESO GENTICA DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 05002816A |
Most Important Dates
| Enumeration Date: | 07/20/2020 |
| Last Updated: | 07/20/2020 |
Provider Practice Location
303 E 89TH AVE
MERRILLVILLE
IN
464108126
Practice Location Phone/Fax
| Phone: | 2197383500 |
| Fax: | 2197386624 |
Provider Mailing Location
303 E 89TH AVE
MERRILLVILLE
IN
464108126
Provider Mailing Phone/Fax
| Phone: | 2197383500 |
| Fax: | 2197386624 |