MEDICARE: DAGNI GLEASON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	907	MT

General Provider Information

NPI Number	:	1083996284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAGNI GLEASON PT

Provider Business Mailing Address
First Line	:	2926 6TH AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2110
Country	:	US
Telephone Number	:	406-727-7740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2926 6TH AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2110
Country	:	US
Telephone Number	:	406-727-7740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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