Provider Demographics
NPI:1508555749
Name:GAUTREAUX, GLORIA LOUISE (LMT,MMP,MLD-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:LOUISE
Last Name:GAUTREAUX
Suffix:
Gender:F
Credentials:LMT,MMP,MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LITTLE CREEK DAM RD
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-8620
Mailing Address - Country:US
Mailing Address - Phone:757-812-5568
Mailing Address - Fax:
Practice Address - Street 1:2705 LITTLE CREEK DAM RD
Practice Address - Street 2:
Practice Address - City:TOANO
Practice Address - State:VA
Practice Address - Zip Code:23168-8620
Practice Address - Country:US
Practice Address - Phone:757-812-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist