Provider Demographics
NPI:1326736828
Name:GLADE, SAMUEL C (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:GLADE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:C
Other - Last Name:GLADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:549 BRIANA LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8161
Mailing Address - Country:US
Mailing Address - Phone:651-214-0759
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2595
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist