MEDICARE: MS. JOANN COBB GLAZIER CERTIFIED MASTO. FIT

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	332B00000X	Durable Medical Equipment & Medical Supplies	039541384392	VA

General Provider Information

NPI Number	:	1205021706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANN COBB GLAZIER CERTIFIED MASTO. FIT

Provider Business Mailing Address
First Line	:	2200 BOULEVARD
Second Line	:	SUITE B
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-520-0484
Fax Number	:	804-520-0729

Provider Business Practice Location Address
First Line	:	2200 BOULEVARD
Second Line	:	SUITE B
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-520-0484
Fax Number	:	804-520-0729

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

Provider Enumeration Date	:	09/09/2007
Last Update Date	:	09/09/2007

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