Provider Demographics
NPI:1952573420
Name:OZARKA, CARLIE M (MPT)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:M
Last Name:OZARKA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:FRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:365 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5526
Practice Address - Country:US
Practice Address - Phone:847-930-5950
Practice Address - Fax:847-930-5951
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216860024Medicare PIN
ILR00848Medicare PIN
ILK53178Medicare PIN
ILK53179Medicare PIN