Provider Demographics
NPI:1841348158
Name:GLENN, PATRICIA D (LMP, LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GLENN
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13708 97TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1874
Mailing Address - Country:US
Mailing Address - Phone:503-269-0625
Mailing Address - Fax:
Practice Address - Street 1:13708 97TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-1874
Practice Address - Country:US
Practice Address - Phone:503-269-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009884225700000X, 172M00000X
OR11906172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist