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Individual

MR. SCOTT JASON GLICKAUF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LAT ATC

Contact information

Practice address
2716 ASHTON DR, WILMINGTON, NC 28412-2489
(910) 763-7344
Mailing address
4159 LAKE AVE, WILMINGTON, NC 28403
(910) 350-0492

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0440
NC

Other

Enumeration date
09/12/2006
Last updated
07/08/2007
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