Healthcare Provider Details

I. General information

NPI: 1982819967
Provider Name (Legal Business Name): PAUL EUGENE GLYNN PT, DPT, OCS,FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST STE 7
LEXINGTON MA
02420-4640
US

IV. Provider business mailing address

76 BEDFORD ST STE 7
LEXINGTON MA
02420-4640
US

V. Phone/Fax

Practice location:
  • Phone: 781-862-0200
  • Fax: 781-862-0600
Mailing address:
  • Phone: 781-862-0200
  • Fax: 781-862-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11353
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: