Provider Demographics
NPI:1598846750
Name:STRATTON, GLEN MICHAEL (MA ATC PT)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:MICHAEL
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MA ATC PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 E BASELINE # 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-503-2010
Mailing Address - Fax:480-503-2300
Practice Address - Street 1:3941 E BASELINE # 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-503-2010
Practice Address - Fax:480-503-2300
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27627Medicare ID - Type Unspecified