Provider Demographics
NPI:1770603540
Name:GLENFIELD, SUSAN A (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:GLENFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36288
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95158-6288
Mailing Address - Country:US
Mailing Address - Phone:408-226-2000
Mailing Address - Fax:408-226-2018
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:STE 14
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3488
Practice Address - Country:US
Practice Address - Phone:408-226-2000
Practice Address - Fax:208-226-2018
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PT71620Medicare ID - Type Unspecified