Basic Information
| Provider Information | |||||||||
| NPI: | 1770827164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLOVER | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3309 BROOKSIDE LN | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237034001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573147616 | ||||||||
| FaxNumber: | 7573147517 | ||||||||
| Practice Location | |||||||||
| Address1: | 576 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236041373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573147616 | ||||||||
| FaxNumber: | 7573147517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Y00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist |
No ID Information.