Basic Information
Provider Information
NPI: 1992998116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGLOTHLEN
FirstName: DAVID
MiddleName: LILBURN
NamePrefix: MR.
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 N SAINT PAUL ST
Address2: SUITE 4200
City: DALLAS
State: TX
PostalCode: 752013801
CountryCode: US
TelephoneNumber: 8669530011
FaxNumber: 8669530012
Practice Location
Address1: 3001 E EVESHAM RD
Address2:  
City: VOORHEES
State: NJ
PostalCode: 080439547
CountryCode: US
TelephoneNumber: 8567511600
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/21/2007
LastUpdateDate: 08/21/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X40QB00141600NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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