Provider Demographics
NPI:1033248406
Name:MCGLASSON, CHARLENE G (PT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:G
Last Name:MCGLASSON
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:PO BOX 32569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2569
Mailing Address - Country:US
Mailing Address - Phone:615-243-8152
Mailing Address - Fax:865-692-2352
Practice Address - Street 1:501 SAUNDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1588
Practice Address - Country:US
Practice Address - Phone:615-527-9026
Practice Address - Fax:615-265-5005
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34152251G0304X
TN12673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
COC44818Medicare PIN
CO448418Medicare PIN
COC3415Medicare PIN