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General NPI Number Information
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NPI Number | 1740391721
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Entity Type | Individual
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Provider Name | STACY LYNNE GLASS MSPT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 625 MADISON AVE SECOND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-1801
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Country | US
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Telephone | 212-891-2172
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 2ND AVE APT. #3C
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City | NEW YORK
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State | NY
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Zip | 10021-4506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 015829
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License Number State | NY
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