Provider Demographics
NPI:1972814333
Name:SCANLAN, JOSEPH GLENN (DPT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GLENN
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 SYBERTON RD
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-8814
Mailing Address - Country:US
Mailing Address - Phone:814-472-7590
Mailing Address - Fax:
Practice Address - Street 1:790 SYBERTON ROAD
Practice Address - Street 2:
Practice Address - City:GALLITZIN
Practice Address - State:PA
Practice Address - Zip Code:16641-8814
Practice Address - Country:US
Practice Address - Phone:814-472-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist