Provider Demographics
NPI:1033192190
Name:RICHARD P. CARR PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RICHARD P. CARR PHYSICAL THERAPY INC
Other - Org Name:PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-602-4105
Mailing Address - Street 1:PO BOX 612260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-2260
Mailing Address - Country:US
Mailing Address - Phone:877-325-2776
Mailing Address - Fax:408-945-4011
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:STE 550
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6204
Practice Address - Country:US
Practice Address - Phone:408-294-3922
Practice Address - Fax:408-294-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196223400OtherDOL
CA8157014OtherAETNA
CA2534479OtherCIGNA
CAZZZ60364ZOtherBLUESHIELD