Provider Demographics
NPI:1770693525
Name:CARMEL ORTHOPEDIC & SPORTS THERAPY
Entity type:Organization
Organization Name:CARMEL ORTHOPEDIC & SPORTS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:831-620-0744
Mailing Address - Street 1:245 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:831-620-0744
Mailing Address - Fax:831-620-0711
Practice Address - Street 1:2149 H DE LA ROSA SR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-678-7333
Practice Address - Fax:831-678-7336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARMEL ORTHOPEDIC & SPORTS THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 13182225100000X
CAPT 29731225100000X
CAPT 12926225100000X
CAPT 7859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ563972OtherBLUE SHIELD
CA00PT78592OtherBLUE CROSS
CAZZZ27576ZMedicare PIN