Provider Demographics
NPI:1477171262
Name:GLASS, LYDIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BATESVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6823
Mailing Address - Country:US
Mailing Address - Phone:864-236-8146
Mailing Address - Fax:
Practice Address - Street 1:980 BATESVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6823
Practice Address - Country:US
Practice Address - Phone:864-236-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19501225100000X
SCPT.10653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist