Provider Demographics
NPI:1184017204
Name:GLYNN, MEGHAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GLYNN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 TANAGER CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-6408
Mailing Address - Country:US
Mailing Address - Phone:614-593-2355
Mailing Address - Fax:
Practice Address - Street 1:3195 KNIGHT WAY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4409
Practice Address - Country:US
Practice Address - Phone:616-526-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program