Provider Demographics
NPI:1174825756
Name:GLAVES, ANDREW MAX (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MAX
Last Name:GLAVES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S POTOMAC ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4536
Mailing Address - Country:US
Mailing Address - Phone:303-671-2134
Mailing Address - Fax:303-671-2142
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:SUITE 350
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-671-2134
Practice Address - Fax:303-671-2142
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist