Individual
CARLY HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
600 W VAN BUREN ST, #106, CHICAGO, IL 60607-3708
(312) 361-3449
Mailing address
600 W VAN BUREN ST, #106, CHICAGO, IL 60607-3708
(312) 361-3449
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013085
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070013085
LICENSE NUMBER
IL
Enumeration date
01/18/2007
Last updated
12/11/2012
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