Jacques Gideon Van Der Glas

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P4116 Issued in NC

Practice address

1721 Bald Hill Loop
Madison, NC 27025-7624

Phone

(336) 548-9658

NPI assigned

Aug 9, 2018

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 9, 2018.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533772800000",
    "number": "1740769843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 BALD HILL LOOP",
            "city": "MADISON",
            "state": "NC",
            "postal_code": "270257624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BALD HILL LOOP",
            "city": "MADISON",
            "state": "NC",
            "postal_code": "270257624",
            "telephone_number": "336-548-9658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER GLAS",
        "first_name": "JACQUES",
        "middle_name": "GIDEON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P4116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence S Slotnick, MD
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• William L Webster, PA-C
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• William H. Lewis, Jr. DDS PA
• Tammy Wray, RPH

• All providers in Madison, NC
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.