Provider Demographics
NPI:1902047350
Name:GLENN, JESSICA ALIMARIE (PHYSICAL THERAPY ASS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALIMARIE
Last Name:GLENN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY ASS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ALIMARIE
Other - Last Name:KEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 727
Mailing Address - Street 2:304 JACOBS HWY
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-833-2550
Mailing Address - Fax:864-938-9240
Practice Address - Street 1:304 JACOBS HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-2550
Practice Address - Fax:864-938-9240
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSPECIALIST 183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist