Provider Demographics
NPI:1891828836
Name:DUNCAN, GLEN E JR (MPT)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:E
Last Name:DUNCAN
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 JENSEN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2683
Mailing Address - Country:US
Mailing Address - Phone:559-875-2220
Mailing Address - Fax:559-399-3074
Practice Address - Street 1:2315 JENSEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2683
Practice Address - Country:US
Practice Address - Phone:559-875-2220
Practice Address - Fax:559-399-3074
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT212822251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT212821Medicare ID - Type Unspecified