Provider Demographics
NPI:1740008747
Name:GLICK, TIMOTHY SPANGLER (LMT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SPANGLER
Last Name:GLICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2245
Mailing Address - Country:US
Mailing Address - Phone:540-271-3348
Mailing Address - Fax:
Practice Address - Street 1:3575 DONALD ST STE 150
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4759
Practice Address - Country:US
Practice Address - Phone:540-271-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist