| Doctor Name: | MRS. NICOLLE LENNA GLEASON |
| NPI Number: | 1871851634 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | PT-2098 |
| Business Practice Address: | 5640 E Franklin Rd # B Nampa, ID - 836878402 |
| Business Phone Number: | 2084844640 |
| Business Fax Number: | 2084844685 |
| Mailing Address: | 3403 W Lassen St, BOISE |
| State: | ID |
| Postal Code: | 837034734 |
| Phone Number: | 2088698036 |
| Fax Number: | |
| NPI Enumeration Date: | 04/30/2012 |
| NPI Last Update Date: | 04/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-2098 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |