Provider Demographics
NPI:1831488725
Name:GLASS, GEORGE COURTENAY IV (LMT, NCMT, RMT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:COURTENAY
Last Name:GLASS
Suffix:IV
Gender:M
Credentials:LMT, NCMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SUNRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5868
Mailing Address - Country:US
Mailing Address - Phone:970-403-6370
Mailing Address - Fax:
Practice Address - Street 1:801 FLORIDA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4780
Practice Address - Country:US
Practice Address - Phone:970-403-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist