Provider Demographics
NPI:1083987218
Name:GLEMBOCKI, JANELL MEYER (AS)
Entity Type:Individual
Prefix:MS
First Name:JANELL
Middle Name:MEYER
Last Name:GLEMBOCKI
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7662 S MISSION CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-1842
Mailing Address - Country:US
Mailing Address - Phone:414-940-0399
Mailing Address - Fax:
Practice Address - Street 1:7662 S MISSION CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-1842
Practice Address - Country:US
Practice Address - Phone:414-940-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-19
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225200000X
WI1858-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant