Provider Demographics
NPI:1407034259
Name:GLOVER PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:GLOVER PHYSICAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-446-9500
Mailing Address - Street 1:3620 HARLEM ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2042
Mailing Address - Country:US
Mailing Address - Phone:716-446-9500
Mailing Address - Fax:716-446-9501
Practice Address - Street 1:3620 HARLEM ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-2042
Practice Address - Country:US
Practice Address - Phone:716-446-9500
Practice Address - Fax:716-446-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167366Medicaid
NY000626742002OtherBLUE CROSS BLUE SHIELD
NYBA0242OtherCORPORATE PROVIDER ID