Provider Demographics
NPI:1689699605
Name:GLOVER, LEE C (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:C
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5959 S STAPLES ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3846
Mailing Address - Country:US
Mailing Address - Phone:361-994-5251
Mailing Address - Fax:361-994-5257
Practice Address - Street 1:5959 S STAPLES ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3846
Practice Address - Country:US
Practice Address - Phone:361-994-5251
Practice Address - Fax:361-994-5257
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00021472Medicare PIN
TXTXB163467Medicare PIN