Individual
CHERYL ANN BLAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 ACORN LN, MUNDELEIN, IL 60060-4019
(847) 566-9221
Mailing address
17273 W DARTMOOR DR, GRAYSLAKE, IL 60030-3010
(847) 845-8798
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.002558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070.002558
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
02/27/2019
Last updated
02/27/2019
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