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General NPI Number Information
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NPI Number | 1720061971
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Entity Type | Individual
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Provider Name | SUSAN MARIE GLOVER PT
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 1500 WHITE POINT RD
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City | NICEVILLE
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State | FL
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Zip | 32578-4249
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Country | US
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Telephone | 850-896-5592
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Fax | 850-897-0501
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Provider Business Mailing Address
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Address Line | 1214 TENNESSEE AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-2265
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Country | US
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Telephone | 765-617-0042
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 32703
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License Number State | FL
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