Individual
KATHLEEN MARIE GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2125 ELIZABETH AVE, LAURELDALE, PA 19605-2259
(610) 921-9292
(610) 939-9256
Mailing address
16 WETZEL RD, MACUNGIE, PA 18062-2021
(610) 845-3417
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
000352L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225200000X
PHYSICAL THERAPIST ASSISITANT
PA
Enumeration date
09/30/2008
Last updated
10/03/2008
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