Provider Demographics
NPI:1194988550
Name:CHANDLER-GLASS, MARLA RENISE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:RENISE
Last Name:CHANDLER-GLASS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 RAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGILINA
Mailing Address - State:VA
Mailing Address - Zip Code:24598-3146
Mailing Address - Country:US
Mailing Address - Phone:434-575-0209
Mailing Address - Fax:
Practice Address - Street 1:730 LUNENBURG HIGHWAY
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947
Practice Address - Country:US
Practice Address - Phone:434-736-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant