Healthcare Provider Details

I. General information

NPI: 1841348158
Provider Name (Legal Business Name): PATRICIA D GLENN L.M.P., L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13708 97TH AVE NE
KIRKLAND WA
98034-1874
US

IV. Provider business mailing address

13708 97TH AVE NE
KIRKLAND WA
98034-1874
US

V. Phone/Fax

Practice location:
  • Phone: 503-269-0625
  • Fax:
Mailing address:
  • Phone: 503-269-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00009884
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number11906
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00009884
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11906
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: