Provider Demographics
NPI:1467463737
Name:GLOVER, STEPHANIE MCGILL (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MCGILL
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2048 HESPERIA WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505
Mailing Address - Country:US
Mailing Address - Phone:580-698-2517
Mailing Address - Fax:
Practice Address - Street 1:10540 LILLIAN HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-9740
Practice Address - Country:US
Practice Address - Phone:850-698-2517
Practice Address - Fax:850-455-8371
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist