MEDICARE: MR. PAUL JOHN GLEASON 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	0656	AZ
2	2251S0007X	Sports Physical Therapist	0656	AZ
3	2251X0800X	Orthopedic Physical Therapist	0656	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649247651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL JOHN GLEASON P.T.

Provider Business Mailing Address
First Line	:	375 E VIRGINIA AVE
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1220
Country	:	US
Telephone Number	:	602-264-5323
Fax Number	:	602-264-5302

Provider Business Practice Location Address
First Line	:	375 E VIRGINIA AVE
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1220
Country	:	US
Telephone Number	:	602-264-5323
Fax Number	:	602-264-5302

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/27/2007

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