Provider Demographics
NPI:1598985970
Name:GEORGE, GLENDA KAREN
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:KAREN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:KAREN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7521 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-2933
Mailing Address - Country:US
Mailing Address - Phone:817-281-7145
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1984
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2011292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant