Individual
MR. GLENN ALLAN CONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 773-2054
(928) 773-2286
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 773-2054
(928) 773-2286
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1581
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001581
PT LICENSE NUMBER
AZ
Enumeration date
01/16/2007
Last updated
07/08/2007
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