MEDICARE: THERESA GLAWE PT, 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	299050	CA

General Provider Information

NPI Number	:	1972118925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA GLAWE PT, DPT

Provider Business Mailing Address
First Line	:	2285 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2017
Country	:	US
Telephone Number	:	310-531-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2017
Country	:	US
Telephone Number	:	410-948-4948
Fax Number	:

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	11/05/2020

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