Provider Demographics
NPI:1043250764
Name:LABROZZI, GLENN DANIEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DANIEL
Last Name:LABROZZI
Suffix:
Gender:M
Credentials:PT, DPT
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 9897
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-397-6872
Mailing Address - Fax:814-835-0302
Practice Address - Street 1:2374 VILLAGE COMMON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-835-0300
Practice Address - Fax:814-835-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006529L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019443950003Medicaid
PA1302096OtherHIGHMARK BLUE SHIELD
PA067234Medicare ID - Type Unspecified
PA0019443950003Medicaid
PA1302096OtherHIGHMARK BLUE SHIELD