Provider Demographics
NPI:1497360515
Name:GLUNT, CHASITY NICHOLE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:NICHOLE
Last Name:GLUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 WESLO WILLOW DR APT 314
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-1919
Mailing Address - Country:US
Mailing Address - Phone:336-817-8739
Mailing Address - Fax:
Practice Address - Street 1:5505 WESLO WILLOW DR APT 314
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-1919
Practice Address - Country:US
Practice Address - Phone:336-817-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist