Provider Demographics
NPI:1366827099
Name:GLEASON, MARY (DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 FARSON ST 105
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1067
Mailing Address - Country:US
Mailing Address - Phone:740-423-1507
Mailing Address - Fax:740-401-0660
Practice Address - Street 1:809 FARSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1066
Practice Address - Country:US
Practice Address - Phone:740-423-1500
Practice Address - Fax:740-423-1504
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist