Provider Demographics
NPI:1477751832
Name:GLEASON, JO ANNE (MT)
Entity Type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MS
Other - First Name:JO ANNE
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE
Mailing Address - Street 1:FLEX AND FIT JO A NNE GLEASON 350 ROBERTSON STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-655-0855
Mailing Address - Fax:
Practice Address - Street 1:FLEX AND FIT JO A NNE GLEASON 350 ROBERTSON STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-655-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist