Active NPI
Ryan Patrick Glacken, PTA
- Physical Therapy Assistant
- Scranton, PA
National Provider Identifier
1760052351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TE012684
- Practice address
- 3 W Olive St Ste 118
Scranton, PA 18508-2576 - Phone
- (570) 209-7604
- NPI assigned
- Jun 28, 2021
- Sex
- Male
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | TE012684 | PA | Primary |
Addresses
Primary practice location
3 W Olive St Ste 118
Scranton, PA 18508-2576
Mailing address
3 W Olive St Ste 118
Scranton, PA 18508-2576
Phone (570) 209-7604
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE012684 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624838400000",
"number": "1760052351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 W OLIVE ST STE 118",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185082576",
"telephone_number": "570-209-7604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 W OLIVE ST STE 118",
"city": "SCRANTON",
"state": "PA",
"postal_code": "185082576",
"telephone_number": "570-209-7604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLACKEN",
"first_name": "RYAN",
"middle_name": "PATRICK",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-28",
"last_updated": "2021-06-28",
"certification_date": "2021-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TE012684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scranton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.