Healthcare Provider Details

I. General information

NPI: 1053919019
Provider Name (Legal Business Name): HANNA MARY GLEASON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 DANBURY RD
WILTON CT
06897-2510
US

IV. Provider business mailing address

388 DANBURY RD
WILTON CT
06897-2510
US

V. Phone/Fax

Practice location:
  • Phone: 315-250-2448
  • Fax:
Mailing address:
  • Phone: 315-250-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number013186
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: