Provider Demographics
NPI:1821275017
Name:GLIDDEN, NICOLE ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 GORHAM RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9558
Mailing Address - Country:US
Mailing Address - Phone:901-692-3395
Mailing Address - Fax:
Practice Address - Street 1:18 HUNTERS WAY
Practice Address - Street 2:
Practice Address - City:NORTH YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04097-6761
Practice Address - Country:US
Practice Address - Phone:901-692-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7682225100000X
ME3372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist