Provider Demographics
NPI:1609852706
Name:GLASS, ALAYNE F (PT)
Entity Type:Individual
Prefix:
First Name:ALAYNE
Middle Name:F
Last Name:GLASS
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:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:OLD CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12136-0121
Mailing Address - Country:US
Mailing Address - Phone:518-794-9841
Mailing Address - Fax:
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-447-8070
Practice Address - Fax:413-445-4918
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA05120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393223Medicaid
MA10078469OtherCDPHP
MAGLY65410OtherBCBS OF MASSACHUSETTS
MA435802OtherMVP
MA10078469OtherCDPHP