Provider Demographics
NPI:1033892831
Name:GLASER, MAXWELL (LMT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:
Last Name:GLASER
Suffix:
Gender:M
Credentials:LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28864 CONEJO VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3366
Mailing Address - Country:US
Mailing Address - Phone:818-292-2486
Mailing Address - Fax:
Practice Address - Street 1:28864 CONEJO VIEW DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3366
Practice Address - Country:US
Practice Address - Phone:818-292-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist