Provider Demographics
NPI:1134103948
Name:RICHARD P CARR PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RICHARD P CARR PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITTERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-602-4106
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 1:3395 S BASCOM AVE
Practice Address - Street 2:#103
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6770
Practice Address - Country:US
Practice Address - Phone:408-369-8556
Practice Address - Fax:408-369-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021723OtherFIRST HEALTH
CAZZZ60366ZOtherBLUESHIELD
CAZZZ60366ZOtherBLUESHIELD