Provider Demographics
NPI:1699841049
Name:THURMAN, GLENN PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:PATRICK
Last Name:THURMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:GLEN
Other - Last Name:THURMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4582
Practice Address - Country:US
Practice Address - Phone:702-898-7633
Practice Address - Fax:702-898-6433
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10831225100000X
NV2641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068FJOtherBCBSNC
NC068FJOtherBCBSNC