Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070002240 | IL |
NPI | 1003064015 |
---|---|
Provider Name | Ms. Carok Ann Gleason |
First Address | Skokie, IL 60077-2825 |
Second Address | Chicago, IL 60611-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 03/09/2008 |