MEDICARE: JENNA LEIGH GLYNN DPT

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	28314	MD
2	225100000X	Physical Therapist	12600	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184855058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LEIGH GLYNN DPT

Provider Business Mailing Address
First Line	:	23000 MOAKLEY ST STE 102
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2916
Country	:	US
Telephone Number	:	301-475-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	23000 MOAKLEY ST STE 102
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2916
Country	:	US
Telephone Number	:	301-475-5555
Fax Number	:

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	05/17/2022

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