1134103948 NPI number — RICHARD P CARR PHYSICAL THERAPY INC

Table of content: (NPI 1134103948)

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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