Holly Mari Glenn, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

01129 Issued in IA

Practice address

18187 150TH St
Eddyville, IA 52553-8139

Phone

(641) 777-6141

NPI assigned

Jul 28, 2008

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 28, 2008.

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217203200000",
    "number": "1063677151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18187 150TH ST",
            "city": "EDDYVILLE",
            "state": "IA",
            "postal_code": "525538139",
            "telephone_number": "641-777-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18187 150TH ST",
            "city": "EDDYVILLE",
            "state": "IA",
            "postal_code": "525538139",
            "telephone_number": "641-777-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "HOLLY",
        "middle_name": "MARI",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2008-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IA",
            "license": "01129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eddyville Blakesburg Community School District
• Eddyville-Blakesburg-Fremont Community School District
• Shelby Lynne Hinton
• Johnston Telehealth
• Lura Marlene Meyers, RN
• Ottumwa Health Group LLC
• Kayla Van Blaricome, RN

• All providers in Eddyville, IA
• Physical Therapy Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.