Individual
CARRIE L GLAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4710 W 95TH ST, SUITE 1B, OAK LAWN, IL 60453-2546
(708) 529-0348
Mailing address
7600 W COLLEGE DR, PALOS HEIGHTS, IL 60463-1001
(708) 361-3600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006282
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP NUMBER
IL
01
—
1623066
BCBS PROVIDER NUMBER
IL
01
—
367885100
US DEPT OF LABOR
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
Enumeration date
07/07/2006
Last updated
04/09/2013
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