Provider Demographics
NPI:1609671445
Name:GLUECKSMANN, ALYSON
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:GLUECKSMANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 MILBORO DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6126
Mailing Address - Country:US
Mailing Address - Phone:202-577-4473
Mailing Address - Fax:
Practice Address - Street 1:1992 MILBORO DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6126
Practice Address - Country:US
Practice Address - Phone:202-577-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
71708439225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist