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General NPI Number Information
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NPI Number | 1932960671
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Entity Type | Individual
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Provider Name | CASSITTY TYTANNYA ROSE DC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 6018 SENTINEL RD
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City | LAKE PLACID
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State | NY
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Zip | 12946-3649
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Country | US
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Telephone | 518-837-5353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 989
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City | SARANAC LAKE
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State | NY
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Zip | 12983-0989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 013799
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License Number State | NY
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