Basic Information
| Provider Information | |||||||||
| NPI: | 1679797872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLADES PHYSICAL THERAPY AND SPORTS MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334304910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547010528 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334304910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547010528 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BULLEN | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9547010528 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT19361 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.