Provider Demographics
NPI:1447210497
Name:GLICK, ELI (PT)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:GLICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WHITEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1648
Mailing Address - Country:US
Mailing Address - Phone:215-681-4047
Mailing Address - Fax:215-233-1172
Practice Address - Street 1:7 WHITEFIELD DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1648
Practice Address - Country:US
Practice Address - Phone:215-681-4047
Practice Address - Fax:215-233-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-005296L2251S0007X
PAPT-005296-L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA450065Medicare ID - Type UnspecifiedMEDICARE ID NUMBER