Provider Demographics
NPI:1053515858
Name:GLENFIELD AND ASSOCIATES PHYSICAL THERAPY
Entity type:Organization
Organization Name:GLENFIELD AND ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-226-2000
Mailing Address - Street 1:5595 WINFIELD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1220
Mailing Address - Country:US
Mailing Address - Phone:408-226-2000
Mailing Address - Fax:408-226-2018
Practice Address - Street 1:5595 WINFIELD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1220
Practice Address - Country:US
Practice Address - Phone:408-226-2000
Practice Address - Fax:408-226-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25432ZOtherBLUE SHIELD PP #
CT00PT71620Medicare ID - Type Unspecified