Provider Demographics
NPI:1366574352
Name:GLAENZER, CYNTHIA LOUISE (PT CHT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:GLAENZER
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EXECUTIVE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260
Mailing Address - Country:US
Mailing Address - Phone:618-476-3310
Mailing Address - Fax:618-257-6805
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:MEDICAL BUILDING 1 SUITE 470
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-5249
Practice Address - Fax:618-257-6805
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist