Provider Demographics
NPI:1386537546
Name:GLENN, SYDNEY LANE (PT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LANE
Last Name:GLENN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CARRIAGE HILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5329
Mailing Address - Country:US
Mailing Address - Phone:870-565-4770
Mailing Address - Fax:
Practice Address - Street 1:3501 CARRIAGE HILL DR STE A
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5329
Practice Address - Country:US
Practice Address - Phone:870-565-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist