Provider Demographics
NPI:1538430368
Name:GLAVIANO, NEAL (PHD , AT, ATC)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:GLAVIANO
Suffix:
Gender:M
Credentials:PHD , AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W. BANCROFT ST
Mailing Address - Street 2:MAILSTOP 119
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:203-988-4381
Mailing Address - Fax:
Practice Address - Street 1:2801 W. BANCROFT ST
Practice Address - Street 2:MAILSTOP 119
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:203-988-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0050262255A2300X
CT5662255A2300X
VA01260012242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer