MEDICARE: MRS. LORI L GLISSON MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT013686L	PA
2	225100000X	Physical Therapist	5033	SC

General Provider Information

NPI Number	:	1134315963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI L GLISSON MSPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-239-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 BOWMAN RD UNIT 105
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3803
Country	:	US
Telephone Number	:	877-407-3422
Fax Number	:	877-407-4329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	03/26/2025

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