Provider Demographics
NPI:1316122500
Name:SALVA, CHRISTIAN ROBELLE VILLANUEVA (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:CHRISTIAN ROBELLE
Middle Name:VILLANUEVA
Last Name:SALVA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:VILLON
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3509 S GLASGOW CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-7900
Mailing Address - Country:US
Mailing Address - Phone:812-269-2679
Mailing Address - Fax:
Practice Address - Street 1:3509 S GLASGOW CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-7900
Practice Address - Country:US
Practice Address - Phone:812-269-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023848225100000X
IN05011910A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist