Provider Demographics
NPI:1083818041
Name:TOLLIVER, GLORIA BROOKS (LPT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:BROOKS
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 KING RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-2508
Mailing Address - Country:US
Mailing Address - Phone:704-279-1728
Mailing Address - Fax:
Practice Address - Street 1:1547 MOUNTAIN VISTA ROAD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239
Practice Address - Country:US
Practice Address - Phone:336-859-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2251500000XMedicare ID - Type UnspecifiedPT