Provider Demographics
NPI:1346546330
Name:ROSNER, GLENN D (CMT)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:ROSNER
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 OAK GROVE RD # 304
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3615
Mailing Address - Country:US
Mailing Address - Phone:925-808-9925
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4328
Practice Address - Country:US
Practice Address - Phone:925-808-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4843OtherCALIFORNIA MASSAGE THERAPY COUNCIL
CA943904OtherASSOCIATED BODYWORK & MASSAGE PROFESSIONALS