Provider Demographics
NPI:1174795314
Name:ANCIRO, GLEEN BAUTISTA (PT,DPT)
Entity type:Individual
Prefix:MS
First Name:GLEEN
Middle Name:BAUTISTA
Last Name:ANCIRO
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 21089
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11002-1089
Mailing Address - Country:US
Mailing Address - Phone:516-270-3673
Mailing Address - Fax:516-270-3673
Practice Address - Street 1:769 58TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5180
Practice Address - Country:US
Practice Address - Phone:347-889-5889
Practice Address - Fax:347-889-5873
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY023716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist