Provider Demographics
NPI:1770068512
Name:GLIDEWELL, DIANE G
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5987
Mailing Address - Country:US
Mailing Address - Phone:219-689-8403
Mailing Address - Fax:
Practice Address - Street 1:1684 REDBUD DR
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5987
Practice Address - Country:US
Practice Address - Phone:219-689-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant