Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Mark Glade

Individual provider Orthopedic Physical Therapist · NPI 1699571406

Ethan Mark Glade is a Physical Therapist in Private Practice in Salt Lake City, Utah. Qualified in 2024, 2 years ago. Practices with Registered Physical Therapists Inc, a 63-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
2
Licensed in
UT
In the registry since
2025
Specialties on file
2
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Practice location Address checks out

6360 S 3000 E Ste 125
Salt Lake City, UT 84121-6933
Phone: (385) 900-5094
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 14197015-2401 (UT)
Orthopedic Physical Therapist Taxonomy 2251X0800X · Licence 14197015-2401 (UT)

Record details

NPI number1699571406
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 21, 2025
Last updated in NPPESFebruary 21, 2025
Certification dateFebruary 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Registered Physical Therapists Inc — 63 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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