Provider Demographics
NPI:1962627968
Name:GLASER, KEVIN NEAL (MPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:NEAL
Last Name:GLASER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1624
Mailing Address - Country:US
Mailing Address - Phone:714-273-9587
Mailing Address - Fax:714-283-2936
Practice Address - Street 1:524 S MORNINGSTAR DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1624
Practice Address - Country:US
Practice Address - Phone:714-273-9587
Practice Address - Fax:714-283-2936
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist