Provider Demographics
NPI:1912124579
Name:GLOVER, LORI KAY (ATC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KAY
Last Name:GLOVER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 W BROADWAY AVE
Mailing Address - Street 2:SUITE300
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:612-672-7109
Mailing Address - Fax:763-533-0833
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:SUITE300
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:612-672-7109
Practice Address - Fax:763-533-0833
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer