Healthcare Provider Details

I. General information

NPI: 1255566600
Provider Name (Legal Business Name): CARRIE L BRAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE WEINER

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CASTLEBERRY DR
GANSEVOORT NY
12831-2509
US

IV. Provider business mailing address

17 CASTLEBERRY DR
GANSEVOORT NY
12831-2509
US

V. Phone/Fax

Practice location:
  • Phone: 330-701-7432
  • Fax:
Mailing address:
  • Phone: 330-701-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9788
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011957
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number04422401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: