Provider Demographics
NPI:1407034259
Name:GLOVER PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:GLOVER PHYSICAL THERAPY, PLLC
Other - Org Name:GLOVER PHYSICAL THERAPY AND PAIN REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-282-6765
Mailing Address - Street 1:600 PINE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1755
Mailing Address - Country:US
Mailing Address - Phone:716-282-6765
Mailing Address - Fax:716-282-6725
Practice Address - Street 1:600 PINE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1755
Practice Address - Country:US
Practice Address - Phone:716-282-6765
Practice Address - Fax:716-282-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0242OtherCORPORATE PROVIDER ID