Provider Demographics
NPI:1235671603
Name:SARVER-GLEJZER, KATHLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SARVER-GLEJZER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNICORN PARK DR
Mailing Address - Street 2:STE 201
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3324
Mailing Address - Country:US
Mailing Address - Phone:781-782-1300
Mailing Address - Fax:781-782-1350
Practice Address - Street 1:200 UNICORN PARK DR
Practice Address - Street 2:STE 201
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3324
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:781-782-1350
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant