Provider Demographics
NPI:1386739175
Name:RATH, JEAN DUFFY (PT)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:DUFFY
Last Name:RATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4808
Mailing Address - Street 2:CARRIER WELLNESS CENTER - BLDG TR19
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13221
Mailing Address - Country:US
Mailing Address - Phone:315-432-7500
Mailing Address - Fax:315-432-6244
Practice Address - Street 1:6304 THOMPSON RD
Practice Address - Street 2:CARRIER WELLNESS CENTER - BLDG TR19
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206
Practice Address - Country:US
Practice Address - Phone:315-432-7500
Practice Address - Fax:315-432-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013060-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD2731Medicare ID - Type UnspecifiedAA1369