Provider Demographics
NPI:1013606342
Name:PIPINS, GLENNA ARLENE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:ARLENE
Last Name:PIPINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2085
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8885
Mailing Address - Country:US
Mailing Address - Phone:918-798-3478
Mailing Address - Fax:
Practice Address - Street 1:5204 JACQUELYN LANE
Practice Address - Street 2:#12
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7733
Practice Address - Country:US
Practice Address - Phone:918-440-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant