1396271540 NPI number — MR. CARL JOSEPH CLARIZIO III ATC, LAT, M.ED.

Table of content: MR. CARL JOSEPH CLARIZIO III ATC, LAT, M.ED. (NPI 1396271540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396271540 NPI number — MR. CARL JOSEPH CLARIZIO III ATC, LAT, M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARIZIO
Provider First Name:
CARL
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
ATC, LAT, M.ED.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARIZIO
Provider Other First Name:
C.J.
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
ATC, LAT, M.ED.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396271540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 10TH ST
Provider Second Line Business Mailing Address:
PO BOX 555
Provider Business Mailing Address City Name:
PAWNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62558-9178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-494-0606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-494-0606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  1427 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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