MEDICARE: MR. GLEN JON HINCHEY

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	19498	FL

General Provider Information

NPI Number	:	1710368758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLEN JON HINCHEY

Provider Business Mailing Address
First Line	:	865 7TH ST S
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4208
Country	:	US
Telephone Number	:	813-508-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W CYPRESS ST STE 401
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-4145
Country	:	US
Telephone Number	:	813-990-8880
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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