Individual provider Active NPI

Jane Glaser-Gormally, PT

  • Physical Therapist
  • Salt Lake City, UT
National Provider Identifier
1104007947
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
271095-2401 Issued in UT
Practice address
4568 Highland Dr Ste 140
Salt Lake City, UT 84117-4234
Phone
(801) 557-6733
NPI assigned
Nov 20, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 271095-2401 UT Primary

Addresses

Primary practice location

4568 Highland Dr Ste 140
Salt Lake City, UT 84117-4234

Mailing address

4568 Highland Dr Ste 140
Salt Lake City, UT 84117-4234
Phone (801) 557-6733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
271095-2401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Badlands Therapy Services Physical Therapist Past Accepting new patients
Balanced Body Physical Therapy Physical Therapist PastSince Aug 15, 2008 Accepting new patients
Black Hills Pediatric Therapy, LLC Physical Therapist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1104007947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4568 HIGHLAND DR STE 140",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174234",
            "telephone_number": "801-557-6733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4568 HIGHLAND DR STE 140",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174234",
            "telephone_number": "801-557-6733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASER-GORMALLY",
        "first_name": "JANE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "271095-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.