Provider Demographics
NPI:1013086131
Name:GLENN, NATALIA ROTHEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:ROTHEY
Last Name:GLENN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GROVE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4114
Mailing Address - Country:US
Mailing Address - Phone:203-403-3519
Mailing Address - Fax:
Practice Address - Street 1:90 GROVE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4114
Practice Address - Country:US
Practice Address - Phone:203-403-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027428-1225100000X
CT9028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1013086131OtherANTHEM BLUE CROSS