Provider Demographics
NPI:1548884141
Name:GLASSMEYER, JACOB KYLE
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:KYLE
Last Name:GLASSMEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 DUNES CT APT 301
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1019
Mailing Address - Country:US
Mailing Address - Phone:407-569-6229
Mailing Address - Fax:
Practice Address - Street 1:8805 DUNES CT APT 301
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1019
Practice Address - Country:US
Practice Address - Phone:407-569-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer