Provider Demographics
NPI:1689167512
Name:GLICK, JARED CALVO (DPT)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:CALVO
Last Name:GLICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 PRYTANIA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5261
Mailing Address - Country:US
Mailing Address - Phone:206-953-4646
Mailing Address - Fax:
Practice Address - Street 1:1772 PRYTANIA ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5261
Practice Address - Country:US
Practice Address - Phone:206-953-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10441R225100000X
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist