Healthcare Provider Details

I. General information

NPI: 1740141134
Provider Name (Legal Business Name): JOSEPH CALVIN ROQUE GASPAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W 94TH PL
CROWN POINT IN
46307-1710
US

IV. Provider business mailing address

502 E 1100 N
CHESTERTON IN
46304-9697
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-5850
  • Fax: 219-250-2072
Mailing address:
  • Phone: 219-926-5850
  • Fax: 219-250-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: