Provider Demographics
NPI:1992998116
Name:MCGLOTHLEN, DAVID LILBURN (PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LILBURN
Last Name:MCGLOTHLEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:325 N SAINT PAUL ST
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3801
Mailing Address - Country:US
Mailing Address - Phone:866-953-0011
Mailing Address - Fax:866-953-0012
Practice Address - Street 1:3001 E EVESHAM RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9547
Practice Address - Country:US
Practice Address - Phone:856-751-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00141600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant