Provider Demographics
NPI:1447718606
Name:GLANTZ, ANDREA (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 VALLEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2672
Mailing Address - Country:US
Mailing Address - Phone:540-535-7222
Mailing Address - Fax:540-535-1271
Practice Address - Street 1:3052 VALLEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2672
Practice Address - Country:US
Practice Address - Phone:540-535-7222
Practice Address - Fax:540-535-1271
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052126762251X0800X
PAPT0266002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT026600OtherBOARD OF PT LICENSING