Provider Demographics
NPI:1225223316
Name:SALDANHA, GLENN JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:JOSEPH
Last Name:SALDANHA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 GLEN LAKES CIR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2144
Mailing Address - Country:US
Mailing Address - Phone:727-298-6021
Mailing Address - Fax:
Practice Address - Street 1:1902 GLEN LAKES CIR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2144
Practice Address - Country:US
Practice Address - Phone:727-298-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT13158OtherFL DOH