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General NPI Number Information
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NPI Number | 1023235793
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Entity Type | Organization
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Legal Business Name | GLORY REHABILITATION & CONSULTANCY SERVICES,INC.,
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9715 MONROE ST
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City | CROWN POINT
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State | IN
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Zip | 46307-5452
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Country | US
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Telephone | 219-689-3390
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Fax | 219-226-0938
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Provider Business Mailing Address
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Address Line | 9715 MONROE ST
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City | CROWN POINT
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State | IN
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Zip | 46307-5452
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Country | US
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Telephone | 219-689-3390
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Fax | 219-226-0938
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FELIX OLUSEGUN ODUSAGA
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Credential | PT, DPT
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Telephone | 219-689-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05005317A
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License Number State | IN
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