Provider Demographics
NPI:1598104309
Name:GLEATON, J. SCOTT (LMT)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:SCOTT
Last Name:GLEATON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-5421
Mailing Address - Country:US
Mailing Address - Phone:334-497-5253
Mailing Address - Fax:
Practice Address - Street 1:189 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-6725
Practice Address - Country:US
Practice Address - Phone:334-497-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3655225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist