Provider Demographics
NPI:1588020556
Name:GLYNN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GLYNN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-862-0200
Mailing Address - Street 1:76 BEDFORD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4640
Mailing Address - Country:US
Mailing Address - Phone:781-862-0200
Mailing Address - Fax:781-862-0600
Practice Address - Street 1:76 BEDFORD ST STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4640
Practice Address - Country:US
Practice Address - Phone:781-862-0200
Practice Address - Fax:781-862-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11353261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
S100276997OtherPTAN