Provider Demographics
NPI:1578073433
Name:MACDUFF, GLENDON HARRIS (DPT)
Entity Type:Individual
Prefix:
First Name:GLENDON
Middle Name:HARRIS
Last Name:MACDUFF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S MANHATTAN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4705
Mailing Address - Country:US
Mailing Address - Phone:925-395-1179
Mailing Address - Fax:
Practice Address - Street 1:1415 S MANHATTAN PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4705
Practice Address - Country:US
Practice Address - Phone:925-395-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist