Provider Demographics
NPI:1083311724
Name:GLASS PT & PERFORMANCE
Entity Type:Organization
Organization Name:GLASS PT & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:256-513-9525
Mailing Address - Street 1:28 ASTORIA LN SE
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-0801
Mailing Address - Country:US
Mailing Address - Phone:256-513-9525
Mailing Address - Fax:
Practice Address - Street 1:326 SUTTON RD SE
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9370
Practice Address - Country:US
Practice Address - Phone:256-513-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy