Provider Demographics
NPI:1538362637
Name:SARGENT, GLEN SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:SCOTT
Last Name:SARGENT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ASPEN LOOP
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3306
Mailing Address - Country:US
Mailing Address - Phone:406-752-5611
Mailing Address - Fax:
Practice Address - Street 1:185 CRESTLINE AVE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3573
Practice Address - Country:US
Practice Address - Phone:406-752-9622
Practice Address - Fax:406-752-9602
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist