Provider Demographics
NPI:1144623117
Name:GLASS, PAUL EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:GLASS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4204
Mailing Address - Country:US
Mailing Address - Phone:330-631-0010
Mailing Address - Fax:330-631-0011
Practice Address - Street 1:129 5TH ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4204
Practice Address - Country:US
Practice Address - Phone:330-631-0010
Practice Address - Fax:330-631-0011
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH394640Medicare Oscar/Certification