Active NPI
Craig B. Glenn, MA
- Physical Therapist
- Moundsville, WV
National Provider Identifier
1700279312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT002655
- Practice address
- Wvu Home Health 100 Teletech Drive
Suite 101
Moundsville, WV 26041 - Phone
- (304) 843-3379
- Fax
- (304) 221-3073
- NPI assigned
- Mar 7, 2015
- Last updated
- Dec 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT002655 | WV | Primary |
Addresses
Primary practice location
Wvu Home Health 100 Teletech Drive
Suite 101
Moundsville, WV 26041
Mailing address
100 Teletech Drive
Suite 101
Moundsville, WV 26041
Phone (304) 843-3379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT002655 | WV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain River Physical Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- New Martinsville, WV
- NPI 1710182274
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1700279312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TELETECH DRIVE",
"address_2": "SUITE 101",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "26041",
"telephone_number": "304-843-3379",
"fax_number": "304-221-3013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WVU HOME HEALTH 100 TELETECH DRIVE",
"address_2": "SUITE 101",
"city": "MOUNDSVILLE",
"state": "WV",
"postal_code": "26041",
"telephone_number": "304-843-3379",
"fax_number": "304-221-3073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "CRAIG",
"middle_name": "B.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-07",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT002655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moundsville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.