Provider Demographics
NPI:1053480616
Name:GLOZMAN, ELIZABETH (MSPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GLOZMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PENN ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3908
Mailing Address - Country:US
Mailing Address - Phone:310-426-9570
Mailing Address - Fax:
Practice Address - Street 1:111 PENN ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3908
Practice Address - Country:US
Practice Address - Phone:310-426-9570
Practice Address - Fax:310-426-9572
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66790ZOtherBLUE SHIELD GROUP#
CA204219365OtherTAX IDENTIFICATION
CAZZZ66790ZOtherBLUE SHIELD GROUP#
CAWPT16305CMedicare ID - Type UnspecifiedPERSONAL #