Provider Demographics
NPI:1457602617
Name:GLOSNER REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:GLOSNER REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GLOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-696-5701
Mailing Address - Street 1:1009 OLD STATE ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:HUNKER
Mailing Address - State:PA
Mailing Address - Zip Code:15639-1231
Mailing Address - Country:US
Mailing Address - Phone:724-696-5701
Mailing Address - Fax:724-696-3248
Practice Address - Street 1:1009 OLD STATE ROUTE 119
Practice Address - Street 2:
Practice Address - City:HUNKER
Practice Address - State:PA
Practice Address - Zip Code:15639-1231
Practice Address - Country:US
Practice Address - Phone:724-696-5701
Practice Address - Fax:724-696-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007095L225100000X
PASL004697L235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA418774Medicare UPIN