Provider Demographics
NPI:1982851580
Name:RICE, GLENNA (DPT)
Entity type:Individual
Prefix:DR
First Name:GLENNA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:GLENNA
Other - Middle Name:RICE
Other - Last Name:KEOGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:49 GRACELAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1921
Mailing Address - Country:US
Mailing Address - Phone:415-235-2807
Mailing Address - Fax:
Practice Address - Street 1:49 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1921
Practice Address - Country:US
Practice Address - Phone:415-235-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist