Provider Demographics
NPI:1134315963
Name:GLISSON, LORI L (MSPT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:GLISSON
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:PEACOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-239-7217
Mailing Address - Fax:
Practice Address - Street 1:1156 BOWMAN RD UNIT 105
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3803
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013686L225100000X, 225100000X
SC5033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist