Provider Demographics
NPI:1780028480
Name:GLOVER, BENJAMIN SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-0739
Mailing Address - Country:US
Mailing Address - Phone:731-644-8111
Mailing Address - Fax:731-641-8110
Practice Address - Street 1:109 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4917
Practice Address - Country:US
Practice Address - Phone:731-641-8111
Practice Address - Fax:731-641-8110
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist