Provider Demographics
NPI:1902336209
Name:GLADDEN, LAURA A (MT, MMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:MT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:STERLING CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76951-0117
Mailing Address - Country:US
Mailing Address - Phone:432-208-4276
Mailing Address - Fax:
Practice Address - Street 1:2001 US HIGHWAY 87 S
Practice Address - Street 2:
Practice Address - City:STERLING CITY
Practice Address - State:TX
Practice Address - Zip Code:76951-6001
Practice Address - Country:US
Practice Address - Phone:432-208-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT117965225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist