1053544486 NPI number — LAUREN AUDREY GLOVER PT, DPT, ATC, LAT

Table of content: LAUREN AUDREY GLOVER PT, DPT, ATC, LAT (NPI 1053544486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053544486 NPI number — LAUREN AUDREY GLOVER PT, DPT, ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLOVER
Provider First Name:
LAUREN
Provider Middle Name:
AUDREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, ATC, LAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
LAUREN
Provider Other Middle Name:
AUDREY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053544486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 S MIDLOTHIAN PKWY STE 170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76065-5597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-723-0380
Provider Business Mailing Address Fax Number:
972-723-0276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2851 MATLOCK RD
Provider Second Line Business Practice Location Address:
#442
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-473-6246
Provider Business Practice Location Address Fax Number:
817-473-2014
Provider Enumeration Date:
09/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com