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General NPI Number Information
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NPI Number | 1003524331
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Entity Type | Individual
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Provider Name | ALEXIS GLASBY BS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 4900 MERIDIAN ST NW
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City | NORMAL
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State | AL
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Zip | 35762-7500
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Country | US
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Telephone | 256-372-8457
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Fax |
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Provider Business Mailing Address
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Address Line | 1731 PARKER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1910
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Country | US
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Telephone | 314-278-4474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2548
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License Number State | AL
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