Provider Demographics
NPI:1982819967
Name:GLYNN, PAUL EUGENE (PT, DPT, OCS,FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:GLYNN
Suffix:
Gender:M
Credentials:PT, DPT, OCS,FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BEDFORD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4640
Mailing Address - Country:US
Mailing Address - Phone:781-862-0200
Mailing Address - Fax:781-862-0600
Practice Address - Street 1:76 BEDFORD ST STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4640
Practice Address - Country:US
Practice Address - Phone:781-862-0200
Practice Address - Fax:781-862-0600
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400277013OtherPTAN