| Doctor Name: | GLENDON NICK |
| NPI Number: | 1003214412 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 25314 |
| Business Practice Address: | 7829 Grassy Garth Elkridge, MD - 210756139 |
| Business Phone Number: | 4107992089 |
| Business Fax Number: | |
| Mailing Address: | 7829 Grassy Garth, ELKRIDGE |
| State: | MD |
| Postal Code: | 210756139 |
| Phone Number: | 4107992089 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2014 |
| NPI Last Update Date: | 12/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 25314 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |