Provider Demographics
NPI:1538913298
Name:GRANT-CASE, CARRELLYN RHEA (PT, DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:CARRELLYN
Middle Name:RHEA
Last Name:GRANT-CASE
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ELY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1001
Mailing Address - Country:US
Mailing Address - Phone:315-569-4682
Mailing Address - Fax:
Practice Address - Street 1:3175 E GENESEE ST STE 5
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1613
Practice Address - Country:US
Practice Address - Phone:315-810-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051766-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist