Organization
GLASSON SPORTS MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA ELISE GLASSON M.D. (PRESIDENT)
(757) 412-1005
Entity
Organization
Contact information
Practice address
968 FIRST COLONIAL RD, SUITE 101, VIRGINIA BEACH, VA 23454-3171
(757) 412-1005
(757) 412-1015
Mailing address
PO BOX 844560, BOSTON, MA 02284-4560
(757) 412-1005
(757) 412-1010
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
225100000X
Physical Therapist
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6409351
—
VA
Enumeration date
03/27/2007
Last updated
05/12/2016
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