Provider Demographics
NPI:1760442131
Name:GLYNN, ANNE G (PTA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:G
Last Name:GLYNN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:STE 110
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-556-4424
Mailing Address - Fax:703-556-4435
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:STE 110
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-556-4424
Practice Address - Fax:703-556-4435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2306001544225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant