Basic Information
| Provider Information | |||||||||
| NPI: | 1073597886 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RICHARD P CARR PHYSICAL THERAPY INC | ||||||||
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| OtherOrganizationName: | MOUNTAIN VIEW PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 SOBRANTE WAY | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940864807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087333670 | ||||||||
| FaxNumber: | 4082457968 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 W EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MT VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940402610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509617370 | ||||||||
| FaxNumber: | 6509612360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | LASSON | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4085700510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1411256 | 01 | CA | CIGNA | OTHER | 8157925 | 01 | CA | AETNA | OTHER | ZZZ60367Z | 01 | BLUE SHIELD | OTHER |