Provider Demographics
NPI:1700279312
Name:GLENN, CRAIG B (MA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
Last Name:GLENN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 TELETECH DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041
Mailing Address - Country:US
Mailing Address - Phone:304-843-3379
Mailing Address - Fax:304-221-3013
Practice Address - Street 1:WVU HOME HEALTH 100 TELETECH DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041
Practice Address - Country:US
Practice Address - Phone:304-843-3379
Practice Address - Fax:304-221-3073
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-07
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVPT002655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist