Provider Demographics
NPI:1295280352
Name:MCCOMAS, GLENN MICHAEL JR (DPT)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:MICHAEL
Last Name:MCCOMAS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4936
Mailing Address - Country:US
Mailing Address - Phone:772-223-3440
Mailing Address - Fax:772-221-3373
Practice Address - Street 1:4287 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4936
Practice Address - Country:US
Practice Address - Phone:772-223-3440
Practice Address - Fax:772-221-3373
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist