Provider Demographics
NPI:1952473878
Name:GLASS, LAURA ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:GLASS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:PREDMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:918 HOLLIS CT
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3609
Mailing Address - Country:US
Mailing Address - Phone:410-326-1059
Mailing Address - Fax:
Practice Address - Street 1:13325 DOWELL ROAD
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3004
Practice Address - Country:US
Practice Address - Phone:410-326-2510
Practice Address - Fax:410-326-2510
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2485225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant