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General NPI Number Information
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NPI Number | 1659511012
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Entity Type | Individual
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Provider Name | STEPHEN C. GAMBLIN BCSI, LMT
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Gender | Male
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 2112 S MONTCLAIR AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6814
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Country | US
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Telephone | 812-330-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 S MONTCLAIR AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6814
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Country | US
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Telephone | 812-330-0789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT20902052
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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