Provider Demographics
NPI:1073168340
Name:GLIDDEN, CALVIN BENJAMIN III (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:BENJAMIN
Last Name:GLIDDEN
Suffix:III
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 TIMBER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2509
Mailing Address - Country:US
Mailing Address - Phone:682-760-5420
Mailing Address - Fax:
Practice Address - Street 1:101 HERDNER RD UNIT C
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5362
Practice Address - Country:US
Practice Address - Phone:575-613-1093
Practice Address - Fax:575-613-1093
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist