Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | CT | |
N | 2251S0007X | Physical Therapist - Sports | NY |
NPI | 1053919019 |
---|---|
Provider Name | Miss Hanna Mary Gleason |
First Address | Shelton, CT 06484-7622 |
Second Address | Shelton, CT 06484-7622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2020 |
Last Update Date | 13/10/2020 |