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General NPI Number Information
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NPI Number | 1437825817
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Entity Type | Individual
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Provider Name | CLEVELAND GLOVER JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 2694 MAIN ST
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City | ROCKY HILL
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State | CT
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Zip | 06067-2510
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Country | US
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Telephone | 860-372-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2694 MAIN ST
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City | ROCKY HILL
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State | CT
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Zip | 06067-2510
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Country | US
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Telephone | 201-232-3054
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10719
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License Number State | CT
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