Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1115178 | TX |
NPI | 1053384065 |
---|---|
Provider Name | Ms. Lucy Glenn |
First Address | La Marque, TX 77568-5410 |
Second Address | Galveston, TX 77550-7904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P22725 | (02) | TX |