Provider Demographics
NPI:1760447007
Name:GLASSEY, KIM P (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:P
Last Name:GLASSEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:P
Other - Last Name:ELWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:601 NEW ROAD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1251
Mailing Address - Country:US
Mailing Address - Phone:609-926-1161
Mailing Address - Fax:609-926-3223
Practice Address - Street 1:601 NEW ROAD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1251
Practice Address - Country:US
Practice Address - Phone:609-926-1161
Practice Address - Fax:609-926-3223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB000183002251S0007X, 2251X0800X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant