Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE1002545 | PA |
NPI | 1003284035 |
---|---|
Provider Name | Mrs. Carissa Glessner |
First Address | Somerset, PA 15501-9395 |
Second Address | Somerset, PA 15501-7055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2015 |
Last Update Date | 08/09/2015 |