Provider Demographics
NPI:1265117113
Name:CARUSO, SIERRA JANE
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:JANE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1339
Mailing Address - Country:US
Mailing Address - Phone:607-287-1762
Mailing Address - Fax:
Practice Address - Street 1:32 COHOES RD
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-1811
Practice Address - Country:US
Practice Address - Phone:042-851-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics