Provider Demographics
NPI:1619939717
Name:GLASER, JEREMY EUGENE (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:EUGENE
Last Name:GLASER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 CLUNIE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6521
Mailing Address - Country:US
Mailing Address - Phone:989-996-0277
Mailing Address - Fax:
Practice Address - Street 1:SAGINAW VALLEY STATE UNIVERSITY
Practice Address - Street 2:7400 BAY ROAD
Practice Address - City:UNIVERSITY CENTER
Practice Address - State:MI
Practice Address - Zip Code:48710-0001
Practice Address - Country:US
Practice Address - Phone:989-964-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010001422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer