Provider Demographics
NPI:1942564638
Name:GLANDT, BOBBIE SUE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:BOBBIE SUE
Middle Name:MARIE
Last Name:GLANDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 RIALTO HTS APT 22
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8618
Mailing Address - Country:US
Mailing Address - Phone:307-258-3265
Mailing Address - Fax:
Practice Address - Street 1:320 E FONTANERO ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7529
Practice Address - Country:US
Practice Address - Phone:307-258-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist