Provider Demographics
NPI:1770605941
Name:GLADFELTER, JAMIE MARIE (ATC)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:GLADFELTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14385 CORMORANT WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-7113
Mailing Address - Country:US
Mailing Address - Phone:651-423-4662
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD STE 135
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6770
Practice Address - Country:US
Practice Address - Phone:952-892-2650
Practice Address - Fax:952-892-2654
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer