Individual
CARRIE LYNN MALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
600 NORTHERN BLVD, ALBANY, NY 12204
(518) 471-3221
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
036529
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01746461
RR MEDICARE
NY
Enumeration date
09/06/2013
Last updated
04/13/2021
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