Nathan Owen Glenn, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

20768 Issued in FL

Practice address

951 N Washington Ave BLDG 4
Titusville, FL 32796-2194

Phone

(321) 268-6111

NPI assigned

Jul 31, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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.

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1710233465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 COLUMBIA BLVD APT 1406",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327807821",
            "telephone_number": "828-558-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 N WASHINGTON AVE BLDG 4",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962194",
            "telephone_number": "321-268-6111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3034 Folsom Rd",
            "address_purpose": "LOCATION",
            "city": "Mims",
            "state": "FL",
            "postal_code": "327542911",
            "country_code": "US",
            "telephone_number": "828-558-1388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1982 Rockledge Blvd",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Rockledge",
            "state": "FL",
            "postal_code": "329553760",
            "country_code": "US",
            "telephone_number": "321-631-5366",
            "fax_number": "321-631-5365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "NATHAN",
        "middle_name": "OWEN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-31",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "20768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Codrina Alexandra Baston Geriguis, DDS
• Christina Gerlach
• Lauren Nicole Giambanco, M.S. CFY SLP
• Gabriella Guerra Glassford, DC
• James D Glenn, MD
• Stephen Gregg Godfrey, PSYD,NCC,LMHC.
• Valerie Lynn Gohil, DPT
• George Gomez-Delrio, MD
• Justo Gonzalez, M.D.
• Jodie Good, OTR/L

• Physical Therapy Assistant in Titusville, FL
• Providers in Titusville, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; 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.