Provider Demographics
NPI:1457871956
Name:GLEASON, SARA JESSE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JESSE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:JESSE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1891 STATION NWPKWY
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4259
Mailing Address - Country:US
Mailing Address - Phone:763-755-4275
Mailing Address - Fax:
Practice Address - Street 1:911 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-2172
Practice Address - Country:US
Practice Address - Phone:763-389-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4503OtherTEMPORARY PERMIT TO PRACTICE PHYSICAL THERAPY