Active NPI
Scott Jason Glickauf, LAT ATC
- Physical Therapy Assistant
- Wilmington, NC
National Provider Identifier
1265536882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0440
- Practice address
- 2716 Ashton Dr
Wilmington, NC 28412-2489 - Phone
- (910) 763-7344
- NPI assigned
- Sep 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 0440 | NC | Primary |
Addresses
Primary practice location
2716 Ashton Dr
Wilmington, NC 28412-2489
Mailing address
4159 Lake Ave
Wilmington, NC 28403
Phone (910) 350-0492
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0440 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265536882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4159 LAKE AVE",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "28403",
"telephone_number": "910-350-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2716 ASHTON DR",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284122489",
"telephone_number": "910-763-7344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICKAUF",
"first_name": "SCOTT",
"middle_name": "JASON",
"name_prefix": "Mr.",
"credential": "LAT ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "0440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.