Provider Demographics
NPI:1639247596
Name:KAZIMIR, CARLA JEANNE (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEANNE
Last Name:KAZIMIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16461 BIRCHER ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2918
Mailing Address - Country:US
Mailing Address - Phone:818-368-7328
Mailing Address - Fax:818-368-0455
Practice Address - Street 1:16461 BIRCHER ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2918
Practice Address - Country:US
Practice Address - Phone:818-368-7328
Practice Address - Fax:818-368-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13354Medicare ID - Type Unspecified