MEDICARE: RECLAIM YOUR LIFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1780351593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECLAIM YOUR LIFE LLC

Provider Business Mailing Address
First Line	:	7400 PLEASANT GROVE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-1352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8416 BELLHAVEN BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-6103
Country	:	US
Telephone Number	:	809-272-0021
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSE GLAZE
Credential	:	PT, DPT
Telephone Number	:	763-670-1805

Provider Enumeration Date	:	08/28/2021
Last Update Date	:	07/31/2024

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Directions to “RECLAIM YOUR LIFE LLC ” Practice Location

Language	Start Address	Practice Location

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