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General NPI Number Information
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NPI Number | 1740145820
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Entity Type | Organization
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Legal Business Name | HAVEN PHYSICAL THERAPY & WELLNESS, PC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1173 N DIXIE DR STE 105
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City | SAN DIMAS
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State | CA
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Zip | 91773-1200
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Country | US
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Telephone | 657-366-5878
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Fax |
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Provider Business Mailing Address
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Address Line | 311 E MEDA AVE APT 2
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City | GLENDORA
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State | CA
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Zip | 91741-2628
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Country | US
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Telephone | 657-366-5878
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | ERICA JANE GLADNEY
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Credential | PT, DPT
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Telephone | 559-801-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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