Provider Demographics
NPI:1396271540
Name:CLARIZIO, CARL JOSEPH III (ATC, LAT, MED)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:JOSEPH
Last Name:CLARIZIO
Suffix:III
Gender:M
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:C.J.
Other - Middle Name:
Other - Last Name:CLARIZIO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT, MED
Mailing Address - Street 1:218 10TH ST
Mailing Address - Street 2:PO BOX 555
Mailing Address - City:PAWNEE
Mailing Address - State:IL
Mailing Address - Zip Code:62558-9178
Mailing Address - Country:US
Mailing Address - Phone:217-494-0606
Mailing Address - Fax:
Practice Address - Street 1:218 10TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:IL
Practice Address - Zip Code:62558
Practice Address - Country:US
Practice Address - Phone:217-494-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer