Provider Demographics
NPI:1356555403
Name:SOSSAMAN, GLINDA WELCH (PTA)
Entity type:Individual
Prefix:
First Name:GLINDA
Middle Name:WELCH
Last Name:SOSSAMAN
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 1:3947 LIGHT HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8165
Mailing Address - Country:US
Mailing Address - Phone:901-257-3422
Mailing Address - Fax:901-257-3423
Practice Address - Street 1:54 S PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4619
Practice Address - Country:US
Practice Address - Phone:901-257-3422
Practice Address - Fax:901-257-3423
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000000301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist