Provider Demographics
NPI:1841323961
Name:HERMAN, GLENN (MPT)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30965 BRIDLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4121
Mailing Address - Country:US
Mailing Address - Phone:830-438-7306
Mailing Address - Fax:
Practice Address - Street 1:525 OAK CENTRE DR
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3944
Practice Address - Country:US
Practice Address - Phone:210-297-4525
Practice Address - Fax:210-297-0459
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist