Provider Demographics
NPI:1477204071
Name:CAREY, JOHN LEWIS (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEWIS
Last Name:CAREY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52040 AVENIDA VALLEJO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3250
Mailing Address - Country:US
Mailing Address - Phone:760-296-1003
Mailing Address - Fax:760-296-1003
Practice Address - Street 1:69472 SERENITY RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7921
Practice Address - Country:US
Practice Address - Phone:760-409-6383
Practice Address - Fax:855-586-3292
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist