Provider Demographics
NPI:1154509750
Name:GLENTZ, LAURA ANN (PT, MPT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ANN
Last Name:GLENTZ
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1325
Mailing Address - Country:US
Mailing Address - Phone:908-301-2600
Mailing Address - Fax:908-301-2630
Practice Address - Street 1:313 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1364
Practice Address - Country:US
Practice Address - Phone:908-301-2600
Practice Address - Fax:908-301-2630
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012194002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics