Provider Demographics
NPI:1811957541
Name:CARRUTH, GEORGE E (PT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:CARRUTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 WALTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1230
Mailing Address - Country:US
Mailing Address - Phone:315-478-0380
Mailing Address - Fax:315-478-0388
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 2K
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2200
Practice Address - Fax:315-452-2204
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2009-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY004824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02446028Medicaid
NY02446028Medicaid
NYS91127Medicare UPIN
NYDD5127Medicare PIN