Provider Demographics
NPI:1790569325
Name:GLOVER, LARAMIE ANN
Entity type:Individual
Prefix:
First Name:LARAMIE
Middle Name:ANN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 COUNTY ROAD 388
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78113-3048
Mailing Address - Country:US
Mailing Address - Phone:830-391-2702
Mailing Address - Fax:
Practice Address - Street 1:1025 COUNTY ROAD 388
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:TX
Practice Address - Zip Code:78113-3048
Practice Address - Country:US
Practice Address - Phone:830-391-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTATR-LAT-LIC-29262255A2300X
UT14063560-48102255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000055578OtherNATA BOC