Provider Demographics
NPI:1245968171
Name:GLOSUP, DOUGLAS C (PT, DPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:GLOSUP
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1769
Mailing Address - Country:US
Mailing Address - Phone:210-828-7557
Mailing Address - Fax:210-828-7756
Practice Address - Street 1:414 W SUNSET RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1769
Practice Address - Country:US
Practice Address - Phone:210-828-7557
Practice Address - Fax:210-828-7756
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1364301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist