Provider Demographics
NPI:1881676377
Name:RICHARD P CARR PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RICHARD P CARR PHYSICAL THERAPY INC
Other - Org Name:CALIFORNIA REHABILITATION AND SPORT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-268-7500
Mailing Address - Street 1:2035 CORTE DEL NOGAL STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1445
Mailing Address - Country:US
Mailing Address - Phone:945-260-0010
Mailing Address - Fax:
Practice Address - Street 1:3097 MOORPARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2543
Practice Address - Country:US
Practice Address - Phone:669-247-6170
Practice Address - Fax:669-253-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124847OtherFIRST HEALTH
ZZZ04940ZOtherBLUE SHIELD
CA056712Medicare ID - Type Unspecified