Provider Demographics
NPI:1770625303
Name:GLYNN, TERESA KAY (MSPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAY
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5940 SW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6009
Mailing Address - Country:US
Mailing Address - Phone:305-669-8929
Mailing Address - Fax:
Practice Address - Street 1:1500 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4108
Practice Address - Country:US
Practice Address - Phone:305-725-2159
Practice Address - Fax:305-448-0147
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist