Healthcare Provider Details

I. General information

NPI: 1801399183
Provider Name (Legal Business Name): ZANE GLASGOW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 N BRYANT AVE
EDMOND OK
73013-6242
US

IV. Provider business mailing address

11236 NE 150TH ST
JONES OK
73049-8621
US

V. Phone/Fax

Practice location:
  • Phone: 405-246-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2533
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: