Provider Demographics
NPI:1962741983
Name:GLASGOW, LENA TOTAH (PT, OCS)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:TOTAH
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 MANZANITA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1335
Mailing Address - Country:US
Mailing Address - Phone:714-992-9694
Mailing Address - Fax:714-992-9694
Practice Address - Street 1:1341 MANZANITA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-1335
Practice Address - Country:US
Practice Address - Phone:714-992-9694
Practice Address - Fax:714-992-9694
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic