MEDICARE: SHERRIE GLASSER PHYSICAL THERAPIST JOHN DOUGLAS 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
1	174400000X	Specialist	003072-1	NY

General Provider Information

NPI Number	:	1962578856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERRIE GLASSER PHYSICAL THERAPIST JOHN DOUGLAS PTA

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	:	DIRECTOR
Name	:	JOHN DOUGLAS
Credential	:
Telephone Number	:	516-454-6387

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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