Provider Demographics
NPI:1043398290
Name:CARR, GREGORY ALBERT (REGISTERED PHYSICAL)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALBERT
Last Name:CARR
Suffix:
Gender:M
Credentials:REGISTERED PHYSICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 GREENBACK LANE
Mailing Address - Street 2:#100
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621
Mailing Address - Country:US
Mailing Address - Phone:916-723-3372
Mailing Address - Fax:916-722-5098
Practice Address - Street 1:6560 GREENBACK LANE
Practice Address - Street 2:#100
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621
Practice Address - Country:US
Practice Address - Phone:916-723-3372
Practice Address - Fax:916-722-5098
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT86710Medicare PIN
CAZZZ16561ZMedicare PIN