Provider Demographics
NPI:1649493834
Name:GLICK, MERETE (RPT)
Entity type:Individual
Prefix:
First Name:MERETE
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1102
Mailing Address - Country:US
Mailing Address - Phone:916-456-3735
Mailing Address - Fax:916-456-9154
Practice Address - Street 1:2100 29TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1102
Practice Address - Country:US
Practice Address - Phone:916-456-3735
Practice Address - Fax:916-456-9154
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist