Glen Junior Foreman, PT, DPT, LAT, ATC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

14.013794 Issued in CT

Practice address

60 Market St Ste 130
Avon, CT 06001-4282

Phone

(860) 703-8505

NPI assigned

Jan 25, 2017

Sex

Male

Sole proprietor

Yes

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

Enrolled in CT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Connecticut IncGroup PAC ID 8325203649, 71 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Connecticut, Inc.

  • Physical Therapist
  • Old Greenwich, CT
  • NPI 1265799365

  Orthopedic

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680998400000",
    "number": "1780121012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 MAIN ST",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060323618",
            "telephone_number": "203-988-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MARKET ST STE 130",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060014282",
            "telephone_number": "860-703-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOREMAN",
        "first_name": "GLEN",
        "middle_name": "JUNIOR",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-25",
        "last_updated": "2023-04-09",
        "certification_date": "2023-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CT",
            "license": "14.013794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark C Fletcher, M.D., D.M.D.
• Stacey A Flynt, OD
• Dennis K Foley, PA
• Jeanne Candace Folks, D.MIN, LPC
• Alescia C Ford-Lanza, MS, OTR/L, ATP
• Sarah L Fowler, PA-C
• Kerilee Francis, APRN
• Jason E Frankel, D.C.
• Friendship Circle Inc.
• Beatrice Fritz, RPH

• Orthopedic Physical Therapist in Avon, CT
• Providers in Avon, CT by specialty
• Orthopedic Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.