MEDICARE: GWEN ANN ESHLEMAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05003526A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000111972	OTHER	IN	ANTHEM ID

General Provider Information

NPI Number	:	1467429985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN ANN ESHLEMAN P.T.

Provider Business Mailing Address
First Line	:	33900 HARPER AVE
Second Line	:	STE 104
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	7424 SHADELAND STATION WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3925
Country	:	US
Telephone Number	:	317-912-4620
Fax Number	:	317-912-4621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	02/27/2025

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