Provider Demographics
NPI:1063903060
Name:GLADDEN, SALLY J (DPT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11993 W AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-9529
Mailing Address - Country:US
Mailing Address - Phone:479-276-3458
Mailing Address - Fax:
Practice Address - Street 1:224 S 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4511
Practice Address - Country:US
Practice Address - Phone:479-276-3458
Practice Address - Fax:833-901-4080
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist