Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 25314 | MD |
NPI | 1003214412 |
---|---|
Provider Name | Glendon Nick |
First Address | Elkridge, MD 21075-6139 |
Second Address | Elkridge, MD 21075-6139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2014 |
Last Update Date | 17/12/2014 |