Provider Demographics
NPI:1366817785
Name:GLAZIER, ELAINE RENEE (PT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:RENEE
Last Name:GLAZIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:2010 GARFIELD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2527
Practice Address - Country:US
Practice Address - Phone:304-917-3649
Practice Address - Fax:304-917-3651
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT001904225100000X
OHPT006172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152205Medicaid
WV1366817785Medicaid
WVQ52238AMedicare PIN