MEDICARE: MR. WILLIAM CHRISTOPHER GLOVER ATC/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT437	TN
2	2255A2300X	Athletic Trainer	AT391	KY

General Provider Information

NPI Number	:	1497840649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CHRISTOPHER GLOVER ATC/L

Provider Business Mailing Address
First Line	:	2221 BELL RD
Second Line	:
City	:	MARTIN
State	:	TN
Zip	:	38237
Country	:	US
Telephone Number	:	731-588-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 E REELFOOT AVE
Second Line	:	SUITE 2
City	:	UNION CITY
State	:	TN
Zip	:	38261-6050
Country	:	US
Telephone Number	:	731-885-1077
Fax Number	:	731-885-4728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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