Basic Information
| Provider Information | |||||||||
| NPI: | 1588798532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLADWELL | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | A.T.C., L.A.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2658 ADAMS AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432022606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145458250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 GRANVILLE ST | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432306505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144706240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT.002738 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.