MEDICARE: SHERRIE GLASSER PHYSICAL THERAPIST JOHN DOUGLAS PHYSICAL THERAPIST ASS

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40839P	OTHER	NY	HIP/HEALTHCARE PARTNERS
2	AZ00688	OTHER	NY	MDNY
3	2122337	OTHER	NY	UNITED HEALTH CARE
4	3422589	OTHER	NY	US HEALTHCARE
5	QL0411	OTHER	NY	BLUE CROSS BLUE SHIELD
6	27301	OTHER	NY	CIGNA
7	ANC1349	OTHER	NY	OXFORD
8	76643	OTHER	NY	VYTRA

General Provider Information

NPI Number	:	1144225582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERRIE GLASSER PHYSICAL THERAPIST JOHN DOUGLAS PHYSICAL THERAPIST ASS

Provider Business Mailing Address
First Line	:	1061 N BROADWAY
Second Line	:
City	:	N MASSAPEQUA
State	:	NY
Zip	:	11758-1802
Country	:	US
Telephone Number	:	516-454-6387
Fax Number	:	516-454-6303

Provider Business Practice Location Address
First Line	:	1061 N BROADWAY
Second Line	:
City	:	N MASSAPEQUA
State	:	NY
Zip	:	11758-1802
Country	:	US
Telephone Number	:	516-454-6387
Fax Number	:	516-454-6303

Authorized Official
Title or Position	:	PHYSICAL THERAPIST DIRECTOR
Name	:	SHERRIE GLASSER
Credential	:
Telephone Number	:	516-745-8050

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/04/2011

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