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General NPI Number Information
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NPI Number | 1467484378
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Entity Type | Individual
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Provider Name | CARRIE L GLAZA PT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 4710 W 95TH ST SUITE 1B
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City | OAK LAWN
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State | IL
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Zip | 60453-2546
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Country | US
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Telephone | 708-529-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 W COLLEGE DR
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1001
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Country | US
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Telephone | 708-361-3600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070006282
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License Number State | IL
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