Provider Demographics
NPI:1730529207
Name:GLENN, CARRIE (DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 ESTERO BLVD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-4786
Mailing Address - Country:US
Mailing Address - Phone:239-314-5118
Mailing Address - Fax:
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1340
Practice Address - Country:US
Practice Address - Phone:207-839-5860
Practice Address - Fax:207-839-2499
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist