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General NPI Number Information
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NPI Number | 1841753274
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Entity Type | Individual
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Provider Name | DAVID GLIKIN
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Gender | Male
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 5888 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-3450
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Country | US
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Telephone | 773-769-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 W CRYSTAL LN UNIT 207
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-5444
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Country | US
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Telephone | 847-757-0678
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.007625
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License Number State | IL
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