Provider Demographics
NPI:1023460854
Name:GLASS, MATT
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:GLASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W CANAL CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5632
Mailing Address - Country:US
Mailing Address - Phone:720-504-0126
Mailing Address - Fax:
Practice Address - Street 1:3900 S WADSWORTH BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2203
Practice Address - Country:US
Practice Address - Phone:720-504-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705156243171WH0202X
DE2014605400171WH0202X
NE44690171WH0202X
PAPA112522171WH0202X
WACC AITHRDI864M9171WH0202X
LA882879171WH0202X
MD132123171WH0202X
MNBC663730171WH0202X
MSR17613171WH0202X
NV79204171WH0202X
NM379703171WH0202X
OR206632171WH0202X
CA1001047171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications