Provider Demographics
NPI:1134551864
Name:GLOVER, MICHELLE NIXON (DPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NIXON
Last Name:GLOVER
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 1:6926 HIGHWAY 92 E
Mailing Address - Street 2:
Mailing Address - City:BEE BRANCH
Mailing Address - State:AR
Mailing Address - Zip Code:72013-9082
Mailing Address - Country:US
Mailing Address - Phone:501-654-4364
Mailing Address - Fax:501-224-5460
Practice Address - Street 1:10014 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5598
Practice Address - Country:US
Practice Address - Phone:501-224-5454
Practice Address - Fax:501-224-5460
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3711OtherPT LICENSE