Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT-005296L | PA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT-005296-L | PA |
NPI | 1447210497 |
---|---|
Provider Name | Mr. Eli Glick |
First Address | Lafayette Hill, PA 19444-1648 |
Second Address | Lafayette Hill, PA 19444-1648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 17/02/2014 |