Provider Demographics
NPI:1386953560
Name:GLESNE, JARED (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:GLESNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN
Mailing Address - Street 2:STE 600C
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:2315 DOUGHERTY FERRY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3383
Practice Address - Country:US
Practice Address - Phone:314-238-1130
Practice Address - Fax:314-238-1132
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010034774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist