Provider Demographics
NPI:1659687028
Name:GLAVIN, KAREN (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GLAVIN
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 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-0100
Mailing Address - Country:US
Mailing Address - Phone:207-695-3708
Mailing Address - Fax:207-695-3709
Practice Address - Street 1:364 PRITHAM AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:ME
Practice Address - Zip Code:04441
Practice Address - Country:US
Practice Address - Phone:207-695-5220
Practice Address - Fax:207-695-3709
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist