Healthcare Provider Details

I. General information

NPI: 1295048767
Provider Name (Legal Business Name): MR. DANIEL WILLIAM GLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MOUNTAIN AVE.
PEMBROKE MA
02359
US

IV. Provider business mailing address

PO BOX 1348
PEMBROKE MA
02359-1348
US

V. Phone/Fax

Practice location:
  • Phone: 781-294-4270
  • Fax: 781-293-6307
Mailing address:
  • Phone: 781-294-4270
  • Fax: 781-293-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: