Basic Information
| Provider Information | |||||||||
| NPI: | 1770605941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLADFELTER | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14385 CORMORANT WAY | ||||||||
| Address2: | |||||||||
| City: | ROSEMOUNT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550687113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514234662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 E NICOLLET BLVD STE 135 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528922650 | ||||||||
| FaxNumber: | 9528922654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1621 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.