Healthcare Provider Details

I. General information

NPI: 1467607366
Provider Name (Legal Business Name): REBECCA QUINN GLICKMAN M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14235 PARK CENTER DR
LAUREL MD
20707-5261
US

IV. Provider business mailing address

PO BOX 500
BROOKEVILLE MD
20833-0500
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-8100
  • Fax: 301-498-0009
Mailing address:
  • Phone: 301-498-8100
  • Fax: 301-498-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22691
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT870936
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number22691
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: