Provider Demographics
NPI:1265713887
Name:GLENNEY, SUSAN (PT DPT MS CSCS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GLENNEY
Suffix:
Gender:F
Credentials:PT DPT MS CSCS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT MS CSCS
Mailing Address - Street 1:843 BOLTON RD
Mailing Address - Street 2:U-1249
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1249
Mailing Address - Country:US
Mailing Address - Phone:860-486-8080
Mailing Address - Fax:860-486-8081
Practice Address - Street 1:843 BOLTON RD
Practice Address - Street 2:U-1249
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1249
Practice Address - Country:US
Practice Address - Phone:860-486-8080
Practice Address - Fax:860-486-8081
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003963225100000X
MA007023225100000X
NH001073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist