Provider Demographics
NPI:1639309529
Name:GLADDEN, REBECCA RAE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAE
Last Name:GLADDEN
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 1:175 JEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-8627
Mailing Address - Country:US
Mailing Address - Phone:802-309-8578
Mailing Address - Fax:
Practice Address - Street 1:184 ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3602
Practice Address - Country:US
Practice Address - Phone:802-893-7427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00553042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer