Provider Demographics
NPI:1053384065
Name:GLENN, LUCY (PT)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-5410
Mailing Address - Country:US
Mailing Address - Phone:409-763-7025
Mailing Address - Fax:409-763-7025
Practice Address - Street 1:1810 TREMONT ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7904
Practice Address - Country:US
Practice Address - Phone:409-763-7025
Practice Address - Fax:409-763-8648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11151782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP22725Medicare UPIN
TX83576EMedicare ID - Type Unspecified