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NPI Code Detail

MEDICARE: SUEANN SHARON GLABACH PTA

MEDICARE: SUEANN SHARON GLABACH PTA
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
1225200000XPhysical Therapy Assistant2552MA

General Provider Information

NPI Number : 1568965986
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUEANN SHARON GLABACH PTA
Provider Business Mailing Address
First Line : 66 E HILL BR
Second Line :
City : LEYDEN
State : MA
Zip : 01337-9571
Country : US
Telephone Number : 413-325-1311
Fax Number :
Provider Business Practice Location Address
First Line : 130 COLRAIN RD
Second Line :
City : GREENFIELD
State : MA
Zip : 01301-9625
Country : US
Telephone Number : 413-200-9957
Fax Number : 413-774-3790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 06/16/2018

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