Provider Demographics
NPI:1457796880
Name:GLISSON, DAVID NORWOOD SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NORWOOD
Last Name:GLISSON
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 61022
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-1022
Mailing Address - Country:US
Mailing Address - Phone:912-665-2302
Mailing Address - Fax:912-920-0025
Practice Address - Street 1:7370 HODGSON MEMORIAL DR STE A6
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2538
Practice Address - Country:US
Practice Address - Phone:912-665-2302
Practice Address - Fax:912-920-0025
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97140OtherMANUAL THERAPEUTIC TECHNIQUES