1134103948 NPI number — RICHARD P CARR PHYSICAL THERAPY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134103948 NPI number — RICHARD P CARR PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD P CARR PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134103948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E CALAVERAS BLVD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
MILPITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95035-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-934-4700
Provider Business Mailing Address Fax Number:
408-934-4701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3395 S BASCOM AVE
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95008-6770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-369-8556
Provider Business Practice Location Address Fax Number:
408-369-8560
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZITTERE
Authorized Official First Name:
KATE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
760-602-4106

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2021723 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ60366Z . This is a "BLUESHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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