Provider Demographics
NPI:1952995953
Name:GLOVER, AMANDA LINEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LINEE
Last Name:GLOVER
Suffix:
Gender:F
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 1:100 PLAZA PL STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3479
Mailing Address - Country:US
Mailing Address - Phone:940-242-2002
Mailing Address - Fax:940-271-0128
Practice Address - Street 1:100 PLAZA PL STE 400
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76226-3479
Practice Address - Country:US
Practice Address - Phone:940-242-2002
Practice Address - Fax:940-271-0128
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty