Provider Demographics
NPI:1861430191
Name:CARLIN, GLENN MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:MICHAEL
Last Name:CARLIN
Suffix:
Gender:M
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:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:856-678-3484
Mailing Address - Fax:
Practice Address - Street 1:484 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4912
Practice Address - Country:US
Practice Address - Phone:045-792-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011273225100000X
FL22003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAZ00182Medicare UPIN
NYA670501Medicare UPIN
NY6699888Medicare UPIN
NYQ82991Medicare ID - Type Unspecified
NY51598Medicare UPIN
NY24401Medicare UPIN