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NPI Code Detail

MEDICARE: ERIN M. GLACE M.S.P.T.

MEDICARE: ERIN M. GLACE M.S.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305003722VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2197810OTHERBC/BS MEDIGAP

General Provider Information

NPI Number : 1629056791
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN M. GLACE M.S.P.T.
Provider Business Mailing Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-466-3406
Fax Number : 757-452-3468
Provider Business Practice Location Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-466-3406
Fax Number : 757-452-3468
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 05/18/2024

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