Healthcare Provider Details

I. General information

NPI: 1023591914
Provider Name (Legal Business Name): CAROLYN RUTH BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RAPP RD
ALBANY NY
12203-4491
US

IV. Provider business mailing address

1080 VAUGHN RD
HUDSON FALLS NY
12839-4501
US

V. Phone/Fax

Practice location:
  • Phone: 518-867-3061
  • Fax: 518-867-3066
Mailing address:
  • Phone: 518-932-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001355-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: