Provider Demographics
NPI:1497183214
Name:GLENN, TONIA (CA CMT 18943)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:CA CMT 18943
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 ARVILLA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2631
Mailing Address - Country:US
Mailing Address - Phone:916-504-7509
Mailing Address - Fax:
Practice Address - Street 1:1919 21ST ST
Practice Address - Street 2:101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6827
Practice Address - Country:US
Practice Address - Phone:916-504-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist