MEDICARE: NICOLE ELIZABETH GLIDDEN P.T.

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	7682	TN
2	225100000X	Physical Therapist	3372	ME

General Provider Information

NPI Number	:	1821275017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ELIZABETH GLIDDEN P.T.

Provider Business Mailing Address
First Line	:	245 GORHAM RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9558
Country	:	US
Telephone Number	:	901-692-3395
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 HUNTERS WAY
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6761
Country	:	US
Telephone Number	:	901-692-3395
Fax Number	:

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

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	03/28/2023

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