Provider Demographics
NPI:1477640050
Name:CARLSON, GLENN R (MSPT, DPT)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:R
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6697 HICKORY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1780
Mailing Address - Country:US
Mailing Address - Phone:423-718-4584
Mailing Address - Fax:
Practice Address - Street 1:210 WALMART DR STE 100
Practice Address - Street 2:BENCHMARK PHYSICAL THERAPY
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-5022
Practice Address - Country:US
Practice Address - Phone:423-332-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21112251X0800X
GA0047642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic