Provider Demographics
NPI:1437222080
Name:BROWN, GLENDA M (PT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:54658 OAK LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1862
Mailing Address - Country:US
Mailing Address - Phone:574-255-4840
Mailing Address - Fax:574-255-4840
Practice Address - Street 1:430 WEST CLEVELAND RD.
Practice Address - Street 2:APARTMENT B23
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-243-9640
Practice Address - Fax:574-243-9640
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN05003216-A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253050Medicare PIN