Provider Demographics
NPI:1376149021
Name:GLAUSER, JESSICA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GLAUSER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 W IVY DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7282
Mailing Address - Country:US
Mailing Address - Phone:801-718-0820
Mailing Address - Fax:
Practice Address - Street 1:687 W IVY DR
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7282
Practice Address - Country:US
Practice Address - Phone:801-718-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10720258-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer