MEDICARE: MR. THEODORE ALAN GLATTKE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT24179	CA

General Provider Information

NPI Number	:	1033221551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE ALAN GLATTKE P.T.

Provider Business Mailing Address
First Line	:	3717 MT DIABLO BLVD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3547
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

Provider Business Practice Location Address
First Line	:	3717 MT DIABLO BLVD
Second Line	:	SUITE100
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3588
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/06/2025

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