Provider Demographics
NPI:1376525840
Name:RICHARD P CARR PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RICHARD P CARR PHYSICAL THERAPY INC
Other - Org Name:CALAVERAS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSON
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:408-570-0510
Mailing Address - Street 1:500 E CALAVERAS BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7703
Mailing Address - Country:US
Mailing Address - Phone:408-934-4700
Mailing Address - Fax:408-934-4701
Practice Address - Street 1:500 E CALAVERAS BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7703
Practice Address - Country:US
Practice Address - Phone:408-934-4700
Practice Address - Fax:408-934-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2016-11-30
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
196223400OtherDOL
CA7803529OtherAETNA
CA1411340OtherCIGNA
ZZZ56822ZOtherBLUE SHIELD
CA7803529OtherAETNA