Provider Demographics
NPI:1710368758
Name:HINCHEY, GLEN JON
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:JON
Last Name:HINCHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4208
Mailing Address - Country:US
Mailing Address - Phone:813-508-3491
Mailing Address - Fax:
Practice Address - Street 1:4300 W CYPRESS ST STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4145
Practice Address - Country:US
Practice Address - Phone:813-990-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist