Provider Demographics
NPI:1174821045
Name:FREEMAN, GLENDA MCDANIEL (RPT)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:MCDANIEL
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 COUNTRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4308
Mailing Address - Country:US
Mailing Address - Phone:205-967-4777
Mailing Address - Fax:
Practice Address - Street 1:2807 GREYSTONE COMMERCIAL BLVD
Practice Address - Street 2:SUITE 34
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-9600
Practice Address - Country:US
Practice Address - Phone:205-745-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1123261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy