Provider Demographics
NPI:1710608989
Name:GLANC, ROSS MARTIN (LMT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:MARTIN
Last Name:GLANC
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BRITTANY PL APT 11
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3282
Mailing Address - Country:US
Mailing Address - Phone:608-571-5337
Mailing Address - Fax:
Practice Address - Street 1:6425 NORMANDY LN STE 10
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1133
Practice Address - Country:US
Practice Address - Phone:608-571-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15765-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist