1477751832 NPI number — MS. JO ANNE GLEASON M.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477751832 NPI number — MS. JO ANNE GLEASON M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLEASON
Provider First Name:
JO ANNE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLEASON
Provider Other First Name:
JO ANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASSAGE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477751832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FLEX AND FIT JO A NNE GLEASON 350 ROBERTSON STREET
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-655-0855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FLEX AND FIT JO A NNE GLEASON 350 ROBERTSON STREET
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-655-0855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  46190 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)