Provider Demographics
NPI:1649072059
Name:PETERS, KARRAH
Entity type:Individual
Prefix:
First Name:KARRAH
Middle Name:
Last Name:PETERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 EASTERN PKWY APT 11
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-6124
Mailing Address - Country:US
Mailing Address - Phone:646-675-7041
Mailing Address - Fax:
Practice Address - Street 1:101 ADIRONDACK DR
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-9333
Practice Address - Country:US
Practice Address - Phone:518-873-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist