Provider Demographics
NPI:1932746005
Name:GLASER, LAURA LYNN (MS,PT,CHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:GLASER
Suffix:
Gender:F
Credentials:MS,PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LAC DE VILLE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5647
Mailing Address - Country:US
Mailing Address - Phone:585-341-9409
Mailing Address - Fax:
Practice Address - Street 1:4901 LAC DE VILLE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5647
Practice Address - Country:US
Practice Address - Phone:585-341-9050
Practice Address - Fax:585-341-4252
Is Sole Proprietor?:No
Enumeration Date:2019-12-07
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic