Provider Demographics
NPI:1851429450
Name:GLENN-BRADBY, AIYSHA R (PT, CLT)
Entity Type:Individual
Prefix:MS
First Name:AIYSHA
Middle Name:R
Last Name:GLENN-BRADBY
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:AIYSHA
Other - Middle Name:R
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3045
Mailing Address - Country:US
Mailing Address - Phone:516-616-1111
Mailing Address - Fax:516-616-1112
Practice Address - Street 1:163 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3045
Practice Address - Country:US
Practice Address - Phone:516-616-1111
Practice Address - Fax:516-616-1112
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027729-1OtherLICENSE PT
NYQ52521Medicare UPIN