Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5783 | CO |
N | 2251S0007X | Physical Therapist - Sports | 5783 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 5783 | CO |
NPI | 1457507881 |
---|---|
Provider Name | Glen David Mcleod |
First Address | Aspen, CO 81612-9390 |
Second Address | Aspen, CO 81611-2255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/08/2008 |