Provider Demographics
NPI:1659529899
Name:GLENNA TOLBERT MD A MEDICAL CORP
Entity Type:Organization
Organization Name:GLENNA TOLBERT MD A MEDICAL CORP
Other - Org Name:CENTER FOR REHABILITATION AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:PATRISE
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-784-7197
Mailing Address - Street 1:17609 VENTURA BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5119
Mailing Address - Country:US
Mailing Address - Phone:818-784-7197
Mailing Address - Fax:818-784-3060
Practice Address - Street 1:17609 VENTURA BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5119
Practice Address - Country:US
Practice Address - Phone:818-784-7197
Practice Address - Fax:818-784-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70820208100000X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty