Ethan Mark Glade

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14197015-2401 Issued in UT

Practice address

6360 S 3000 E Ste 125
Salt Lake City, UT 84121-6933

Phone

(385) 900-5094

NPI assigned

Feb 21, 2025

Last updated

Feb 21, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Registered Physical Therapists IncGroup PAC ID 9537151733, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Registered Physical Therapists LLC

  • Physical Therapist
  • Sandy, UT
  • NPI 1477582633
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1699571406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 S 3000 E STE 125",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216933",
            "telephone_number": "385-900-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 S 3000 E STE 125",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216933",
            "telephone_number": "385-900-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADE",
        "first_name": "ETHAN",
        "middle_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "14197015-2401",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "14197015-2401",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Glad, DPT
• Jaclyn C Glad, DPT
• Trevor Glad, MD
• Tyson Kelly Glad
• Corey Glade
• Jenna Glade
• Bruce F Gladwell, CRNA
• Michael A Gladwell, D.M.D., MD
• Stephanie Glaittli
• Sarah Marie Glander

• Physical Therapist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.