Provider Demographics
NPI:1033224415
Name:GLASS, ELIZABETH GOLD (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GOLD
Last Name:GLASS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BLUE CRAB PT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3291
Mailing Address - Country:US
Mailing Address - Phone:912-656-8342
Mailing Address - Fax:
Practice Address - Street 1:1 JOHNSTON ST
Practice Address - Street 2:SUITE 15
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5531
Practice Address - Country:US
Practice Address - Phone:912-353-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006834225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics