Provider Demographics
NPI:1861006009
Name:GLINES, CARLOS (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:GLINES
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 KIETZKE LN STE 104
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2043
Mailing Address - Country:US
Mailing Address - Phone:775-348-8800
Mailing Address - Fax:833-687-1419
Practice Address - Street 1:1749 N STEWART ST STE 50
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-2574
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:833-687-1419
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty