MR. GLENN B LYDA (NPI# 1962557439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962557439 |
| Entity Type | Individual |
| Full Name | MR. GLENN B LYDA |
| Credential | CPO |
| Practice Address |
3305 16th Ave Se Suite 101 Conover NC 28613-9213 |
| Practice Telephone | 8289944808 |
| Practice Fax Number | 8289944809 |
| Mailing Telephone | 8289944808 |
| Mailing Fax Number | 8289944809 |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-06-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7795183 | 05 |
| Street Address |
3305 16TH AVE SE SUITE 101 |
| City | CONOVER |
| State | NC |
| Zip Code | 28613-9213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578533014 | Kevin Eugene Brown | Dentist | 3305 16th Ave Se, Conover, NC 28613-9213 | 2006-01-26 |
| 1164890745 | Creative Prosthetics and Orthotics LLC | Prosthetic/Orthotic Supplier | 3305 16th Ave Se, Suite 101, Conover, NC 28613-9213 | 2015-09-13 |
| 1497181309 | Easter Seals Ucp North Carolina & Virginia | Community Based Residential Treatment Facility, Mental Illness | 3305 16th Ave Se, Conover, NC 28613-9213 | 2013-09-24 |
| 1972768562 | Richard A Riffle | Prosthetist | 3305 16th Ave Se, Suite 101, Conover, NC 28613-9213 | 2008-07-23 |
| 1427244540 | Maxim Habilitation Services, LLC | Day Training, Developmentally Disabled Services | 3305 16th Ave Se, Suite 207a, Conover, NC 28613-9213 | 2007-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386258671 | Samantha Lackey | Hearing Instrument Specialist | 1217-f Nc Highway 16, Conover, NC 28613 | 2020-09-03 |
| 1497313381 | Gjulshana Nurceski | Internal Medicine | 203 1st St East, Conover, NC 28613 | 2019-06-05 |
| 1487162384 | Anthony T Hines | Counselor | 6055 St. Peters Church Road, Conover, NC 28613 | 2018-01-14 |
| 1780195693 | Healthstat Onsite Clinic Hsm Conover | Preventive Medicine | 120 Section House Road, Conover, NC 28613 | 2017-10-18 |
| 1487055612 | Kave Nikbakht | Pharmacist | 201 Zelkova Ct., Wal-mart Pharmacy, Conover, NC 28613 | 2014-09-08 |
| 1326457003 | Michelle Lynn Kirby | Pharmacist | 126 1st Avenue South, Conover, NC 28613 | 2014-08-07 |
| 1255676904 | Norris Franklin Buff | Pharmacist | 498 6th Ave Ne, Conover, NC 28613 | 2012-12-06 |
| 1043560964 | Nicole Elizabeth Flinn | Pharmacist | 508 K 10th Street Nw, Conover, NC 28613 | 2012-09-18 |
| 1508115171 | Jannie Sue Phillips | Occupational Therapist | 2917 14th Ave Ne, Conover, NC 28613 | 2012-08-29 |
| 1861792707 | Susan Kochel Pearce | Physical Therapist | 2372 Eagle Drive, New Beginnings Pediatric Therapy, LLC, Conover, NC 28613 | 2010-10-26 |
| Find all providers in zip 28613 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639430457 | William A Bentley | Prosthetist | 715 Fairgrove Church Rd Se, Suite 203, Conover, NC 28613-9290 | 2012-06-07 |
| 1982997805 | Brett White | Prosthetist | 715 Fairgrove Church Rd Se, Ste 203, Conover, NC 28613-9290 | 2011-05-25 |
| 1972768562 | Richard A Riffle | Prosthetist | 3305 16th Ave Se, Suite 101, Conover, NC 28613-9213 | 2008-07-23 |
| 1457542508 | Scott C Jones | Prosthetist | 715 Fairgrove Church Rd Se, Suite 203, Conover, NC 28613-9290 | 2007-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639782857 | Ashley Brooks | Prosthetist | 2232 Page Rd Ste 104, Durham, NC 27703-7724 | 2020-08-27 |
| 1689282865 | Marquetta L Thomas | Prosthetist | 2203 Southern Ave, Fayetteville, NC 28306-2257 | 2020-07-14 |
| 1053943381 | Ashley K Sorrell | Prosthetist | 24 Wood Lake Dr, Fuquay Varina, NC 27526-4936 | 2020-02-05 |
| 1134764459 | Zachary Roggow | Prosthetist | 3400 Executive Dr Ste 102, Raleigh, NC 27609-7476 | 2019-11-11 |
| 1356990022 | Porshai Juanice Jackson | Prosthetist | 6341 Derryfield Dr, Charlotte, NC 28213-5532 | 2019-09-05 |
| 1164079117 | Sherronda Yancey | Prosthetist | 513 Yadkin St, Henderson, NC 27536-3524 | 2019-08-23 |
| 1962058909 | Tishma Mcgarrell | Prosthetist | 102 N B Street, Bridgeton, NC 28519-2851 | 2019-08-15 |
| 1306400759 | Pure Gold Luxz Hair Beauty Luxury | Prosthetist | 508 Owen Dr, Fayetteville, NC 28304-3417 | 2019-04-30 |
| 1437712601 | Anitra Nash Phifer | Prosthetist | 2483 E Ozark Ave, Gastonia, NC 28054-1421 | 2019-04-15 |
| 1881257046 | Sonja Allen | Prosthetist | 3509 David Cox Rd, Charlotte, NC 28269-2281 | 2019-04-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.