Healthcare Provider Details

I. General information

NPI: 1740145820
Provider Name (Legal Business Name): HAVEN PHYSICAL THERAPY & WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 N DIXIE DR STE 105
SAN DIMAS CA
91773-1200
US

IV. Provider business mailing address

311 E MEDA AVE APT 2
GLENDORA CA
91741-2628
US

V. Phone/Fax

Practice location:
  • Phone: 657-366-5878
  • Fax:
Mailing address:
  • Phone: 657-366-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERICA JANE GLADNEY
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: PT, DPT
Phone: 559-801-2477